Provider Demographics
| NPI: | 1386643294 |
|---|---|
| Name: | KENT COUNTY MEMORIAL HOSPITAL |
| Entity type: | Organization |
| Organization Name: | KENT COUNTY MEMORIAL HOSPITAL |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | VP OF FINANCE |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | JAMES |
| Authorized Official - Middle Name: | MICHAEL |
| 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: | 401-736-1000 |
| 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: | 401-736-1000 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2005-07-21 |
| Last Update Date: | 2024-02-29 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 207RC0000X, 207RP1001X, 207ZP0105X, 2084N0400X, 2086S0129X, 324500000X | ||
| RI | HOS00125 | 282N00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 282N00000X | Hospitals | General Acute Care Hospital | ||
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
| No | 207ZP0105X | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine | Group - Multi-Specialty |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | Group - Multi-Specialty |
| No | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| RI | 0000006181 | Other | KENT COUNTY PHYS PATH |
| RI | 000000001935 | Other | KENT COUNTY MEMORIAL HOSP |
| RI | 0000000021 | Other | KENT COUNTY MEMORIAL HOSP |
| RI | 0000006111 | Other | KENT COUNTY PHYS EKG |
| RI | 0000006112 | Other | KENT COUNTY PHYS PULM |
| RI | 5000154 | Other | KENT COUNTY MEMORIAL HOSP |
| RI | OP00009 | Medicaid | |
| RI | 4100009 | Medicaid | |
| RI | 5000152 | Other | KENT COUNTY MEMORIAL HOSP |
| RI | 709006109 | Other | KENT COUNTY PHYS VASC |
| RI | 900247 | Other | KENT COUNTY MEMORIAL HOSP |
| RI | 0000006109 | Other | KENT COUNTY PHYS VASC |
| RI | 0000006110 | Other | KENT COUNTY PHYS EEG |
| DD3248 | Other | KENT COUNTY HOSPITAL | |
| RI | =========007 | Other | KENT COUNTY MEMORIAL HOSP |
| RI | 0000006181 | Other | KENT COUNTY PHYS PATH |
| RI | 5000152 | Other | KENT COUNTY MEMORIAL HOSP |
| ID | 410009 | Medicare ID - Type Unspecified | MEDICARE PROVIDER NUMBER |
| RI | 0000006112 | Other | KENT COUNTY PHYS PULM |
| RI | 4100009 | Medicaid |
