Provider Demographics
NPI:1649820473
Name:BLOCK ISLAND HEALTH SERVICS
Entity type:Organization
Organization Name:BLOCK ISLAND HEALTH SERVICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-566-7460
Mailing Address - Street 1:PO BOX 919
Mailing Address - Street 2:
Mailing Address - City:BLOCK ISLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02807-0919
Mailing Address - Country:US
Mailing Address - Phone:401-466-2974
Mailing Address - Fax:
Practice Address - Street 1:6 PAYNE RD
Practice Address - Street 2:
Practice Address - City:BLOCK ISLAND
Practice Address - State:RI
Practice Address - Zip Code:02807-7761
Practice Address - Country:US
Practice Address - Phone:401-466-2974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy