Provider Demographics
NPI:1821055567
Name:FAINE SC
Entity Type:Organization
Organization Name:FAINE SC
Other - Org Name:KENT COUNTY SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:WERBER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:401-738-7750
Mailing Address - Street 1:400 BALD HILL ROAD
Mailing Address - Street 2:SUITE 503
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886
Mailing Address - Country:US
Mailing Address - Phone:401-738-7750
Mailing Address - Fax:401-738-9750
Practice Address - Street 1:400 BALD HILL ROAD
Practice Address - Street 2:SUITE 503
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886
Practice Address - Country:US
Practice Address - Phone:401-738-7750
Practice Address - Fax:401-738-9750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIFAS01013261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI57219OtherBLUE CROSS BS OF RI
RI411638OtherBCHIP