Provider Demographics
NPI: | 1184944662 |
---|---|
Name: | AFFINITY PHYSICIANS LLC. |
Entity type: | Organization |
Organization Name: | AFFINITY PHYSICIANS LLC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | VP FINANCE |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JAMES |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BURKE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 401-737-7010 |
Mailing Address - Street 1: | 455 TOLL GATE RD |
Mailing Address - Street 2: | |
Mailing Address - City: | WARWICK |
Mailing Address - State: | RI |
Mailing Address - Zip Code: | 02886-2759 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 401-737-7010 |
Mailing Address - Fax: | 401-736-4546 |
Practice Address - Street 1: | 455 TOLL GATE RD |
Practice Address - Street 2: | |
Practice Address - City: | WARWICK |
Practice Address - State: | RI |
Practice Address - Zip Code: | 02886-2759 |
Practice Address - Country: | US |
Practice Address - Phone: | 401-737-7010 |
Practice Address - Fax: | 401-736-4546 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | KENT COUNTY MEMORIAL HOSPITAL |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2010-06-07 |
Last Update Date: | 2024-01-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
172V00000X, 103G00000X, 104100000X, 207L00000X, 207P00000X, 207RH0003X, 207V00000X, 207VE0102X, 208000000X, 2084N0400X, 2084P0800X, 208600000X, 213ES0103X | ||
RI | 207RC0000X, 207R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 172V00000X | Other Service Providers | Community Health Worker | Group - Multi-Specialty | |
No | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | Group - Multi-Specialty | |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207VE0102X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Reproductive Endocrinology | Group - Multi-Specialty |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 213ES0103X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
RI | AF82916 | Medicaid |