Provider Demographics
NPI:1760532451
Name:NARRAGANSETT INDIAN TRIBE
Entity Type:Organization
Organization Name:NARRAGANSETT INDIAN TRIBE
Other - Org Name:NARRAGANSETT INDIAN HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AUTUMN
Authorized Official - Middle Name:LEAF
Authorized Official - Last Name:SPEARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-364-1268
Mailing Address - Street 1:4533 S COUNTY TRL
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02813-3428
Mailing Address - Country:US
Mailing Address - Phone:401-364-1268
Mailing Address - Fax:401-364-1030
Practice Address - Street 1:51 OLD MILL RD
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:RI
Practice Address - Zip Code:02813-3322
Practice Address - Country:US
Practice Address - Phone:401-364-1268
Practice Address - Fax:401-364-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI4101809Medicaid
RI=========OtherEIN
RI=========OtherEIN