Provider Demographics
NPI:1861445728
Name:NARRAGANSETT BAY ANESTHESIA, LLC
Entity Type:Organization
Organization Name:NARRAGANSETT BAY ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCIVOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-407-7713
Mailing Address - Street 1:1 UNIVERSITY AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2179
Mailing Address - Country:US
Mailing Address - Phone:781-915-0214
Mailing Address - Fax:781-407-7712
Practice Address - Street 1:455 TOLL GATE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2759
Practice Address - Country:US
Practice Address - Phone:781-915-0214
Practice Address - Fax:781-407-7712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9738461Medicaid
RINB54268Medicaid
NHT100650862OtherMEDICARE PIN
RI709003614Medicare PIN