Provider Demographics
NPI:1659418671
Name:COVENTRY PRIMARY CARE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:COVENTRY PRIMARY CARE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MANOWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-821-6981
Mailing Address - Street 1:1620 NOOSENECK HILL RD
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-6705
Mailing Address - Country:US
Mailing Address - Phone:401-821-6981
Mailing Address - Fax:401-821-1352
Practice Address - Street 1:1620 NOOSENECK HILL RD
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-6705
Practice Address - Country:US
Practice Address - Phone:401-821-6981
Practice Address - Fax:401-821-1352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RICP46184Medicaid
RI119081046Medicare PIN