Provider Demographics
NPI:1871691204
Name:WEST BAY ORTHOPAEDICS AND NEUROSURGERY, INC.
Entity Type:Organization
Organization Name:WEST BAY ORTHOPAEDICS AND NEUROSURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:VAUGHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:GOODING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-738-3730
Mailing Address - Street 1:120 CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4336
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4336
Practice Address - Country:US
Practice Address - Phone:401-738-3730
Practice Address - Fax:401-738-3777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI209020102Medicare PIN
5943720002Medicare NSC