Provider Demographics
NPI:1700051513
Name:ST ANNE'S HOSPITAL
Entity Type:Organization
Organization Name:ST ANNE'S HOSPITAL
Other - Org Name:DBATIVERTON PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:401-625-1001
Mailing Address - Street 1:821 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-1334
Mailing Address - Country:US
Mailing Address - Phone:401-625-1001
Mailing Address - Fax:401-625-1584
Practice Address - Street 1:821 MAIN RD
Practice Address - Street 2:
Practice Address - City:TIVERTON
Practice Address - State:RI
Practice Address - Zip Code:02878-1334
Practice Address - Country:US
Practice Address - Phone:401-625-1001
Practice Address - Fax:401-625-1584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAE47156Medicare UPIN
MAA31323Medicare PIN
MA220020Medicare PIN
RI089023502Medicare PIN