Provider Demographics
NPI:1982216974
Name:RHODE ISLAND HEALTH GROUP PC
Entity Type:Organization
Organization Name:RHODE ISLAND HEALTH GROUP PC
Other - Org Name:PARK SQUARE URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:IMRAN
Authorized Official - Last Name:CHAUDRY
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:401-597-5353
Mailing Address - Street 1:63 EDDIE DOWLING HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896-7322
Mailing Address - Country:US
Mailing Address - Phone:401-597-5353
Mailing Address - Fax:401-769-4555
Practice Address - Street 1:65 EDDIE DOWLING HWY
Practice Address - Street 2:
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-7305
Practice Address - Country:US
Practice Address - Phone:401-597-5353
Practice Address - Fax:401-769-4555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-20
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI710001102Medicaid