Provider Demographics
NPI:1689657249
Name:IMAGING NETWORK OF RHODE ISLAND, INC.
Entity Type:Organization
Organization Name:IMAGING NETWORK OF RHODE ISLAND, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATE
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STAINKEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-334-2423
Mailing Address - Street 1:PO BOX 9132
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-9132
Mailing Address - Country:US
Mailing Address - Phone:603-893-9784
Mailing Address - Fax:603-893-8886
Practice Address - Street 1:825 CHALKSTONE AVE
Practice Address - Street 2:ROGERS WILLIAMS MEDICAL CENTER
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-4728
Practice Address - Country:US
Practice Address - Phone:401-456-2204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI2627-9OtherBLUE SHIELD
RI9002627Medicaid
MA9775617Medicaid
RI2627-9OtherBLUE SHIELD