Provider Demographics
NPI:1730294950
Name:MEMORIAL X-RAY SERVICES, LTD.
Entity Type:Organization
Organization Name:MEMORIAL X-RAY SERVICES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT PATIENT ACCOUNTS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DESENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-729-2836
Mailing Address - Street 1:PO BOX 1908
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02862-1908
Mailing Address - Country:US
Mailing Address - Phone:401-729-2836
Mailing Address - Fax:401-729-2721
Practice Address - Street 1:111 BREWSTER ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4400
Practice Address - Country:US
Practice Address - Phone:401-729-2836
Practice Address - Fax:401-729-2721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIHOS001282085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0009742557Medicaid
RI0009000660Medicaid
RI0309000660Medicare PIN