Provider Demographics
NPI:1801848908
Name:MINERAL SPRING PRIMARY CARE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MINERAL SPRING PRIMARY CARE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:POISSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-353-1012
Mailing Address - Street 1:1637 MINERAL SPRING AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-4042
Mailing Address - Country:US
Mailing Address - Phone:401-353-5224
Mailing Address - Fax:401-353-5162
Practice Address - Street 1:1637 MINERAL SPRING AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-4042
Practice Address - Country:US
Practice Address - Phone:401-353-5224
Practice Address - Fax:401-353-5162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIE88754Medicare UPIN
RII30959Medicare UPIN