Provider Demographics
NPI:1649056508
Name:VMD PRIMARY PROVIDERS OF RHODE ISLAND PC
Entity type:Organization
Organization Name:VMD PRIMARY PROVIDERS OF RHODE ISLAND PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR REV CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:FONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-969-0686
Mailing Address - Street 1:PO BOX 30034
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2052
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 PUTNAM PIKE
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-2408
Practice Address - Country:US
Practice Address - Phone:401-757-6160
Practice Address - Fax:401-349-0840
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VMD PRIMARY PROVIDERS OF RHODE ISLAND PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-06
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty