Provider Demographics
NPI:1134191836
Name:MINUTECLINIC LLC
Entity type:Organization
Organization Name:MINUTECLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:PINCINCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-770-3813
Mailing Address - Street 1:PO BOX 772
Mailing Address - Street 2:MINUTECLINIC CREDENTIALING-MC2295
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-0784
Mailing Address - Country:US
Mailing Address - Phone:866-389-2727
Mailing Address - Fax:401-406-3539
Practice Address - Street 1:7955 TUCKERMAN LN
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20854-3243
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:401-406-3539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2024-04-23
Deactivation Date:2007-07-12
Deactivation Code:
Reactivation Date:2008-01-07
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 363A00000X, 363L00000X, 363LF0000X
FL363LF0000X
MD363LF0000X
RI363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADO0776OtherMEDICARE RAILROAD
MDDF2011OtherMEDICARE RAILROAD
AZDO0606OtherMEDICARE RAILROAD
FLDO1341OtherMEDICARE RAILROAD
MDDF2416OtherMEDICARE RAILROAD
MDDF2416OtherMEDICARE RAILROAD
GAGRP7389Medicare PIN
FLQ0465Medicare PIN
MDG01772Medicare PIN
AZ2119818Medicare PIN
MD082NMedicare PIN