Provider Demographics
NPI:1972514305
Name:FAMILY INTERNAL MEDICINE INC
Entity Type:Organization
Organization Name:FAMILY INTERNAL MEDICINE INC
Other - Org Name:BASSAM KHABBAZ MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KHABBAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-333-3445
Mailing Address - Street 1:2295 DIAMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864
Mailing Address - Country:US
Mailing Address - Phone:401-333-3445
Mailing Address - Fax:401-333-3465
Practice Address - Street 1:2295 DIAMOND HILL RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864
Practice Address - Country:US
Practice Address - Phone:401-333-3445
Practice Address - Fax:401-333-3465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI10573207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9004563Medicaid
RI310521OtherBLUE CROSS
RI9004563Medicaid
RI310521OtherBLUE CROSS
H36752Medicare UPIN