Provider Demographics
NPI:1922887157
Name:MDRI LLC
Entity Type:Organization
Organization Name:MDRI LLC
Other - Org Name:GREENWICH BAY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:COFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:CNA/MA
Authorized Official - Phone:401-398-0288
Mailing Address - Street 1:1407 S COUNTY TRL STE 431
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1679
Mailing Address - Country:US
Mailing Address - Phone:401-398-0288
Mailing Address - Fax:401-471-7365
Practice Address - Street 1:1407 S COUNTY TRL STE 432
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-1679
Practice Address - Country:US
Practice Address - Phone:401-398-0288
Practice Address - Fax:401-471-7365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care