Provider Demographics
NPI:1679612477
Name:CITY OF PAWTUCKET RHODE ISLAND
Entity Type:Organization
Organization Name:CITY OF PAWTUCKET RHODE ISLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SISSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-725-2331
Mailing Address - Street 1:PO BOX 844622
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-4622
Mailing Address - Country:US
Mailing Address - Phone:401-725-1422
Mailing Address - Fax:400-172-7236
Practice Address - Street 1:137 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-2129
Practice Address - Country:US
Practice Address - Phone:401-728-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3416L0300X
RIEMS000283416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9007303Medicaid
RI23823OtherBLUE CROSS
RI27812OtherNEIGHBOR HEALTH
RI203239OtherBLUE CHIP
RI203239OtherBLUE CHIP