Provider Demographics
NPI:1669800967
Name:BALD HILL WALK IN AND PRIMARY CARE
Entity type:Organization
Organization Name:BALD HILL WALK IN AND PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:
Authorized Official - Last Name:EDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:401-284-1515
Mailing Address - Street 1:300 QUAKER LN
Mailing Address - Street 2:SUITE 16
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-0159
Mailing Address - Country:US
Mailing Address - Phone:401-825-7400
Mailing Address - Fax:401-284-0625
Practice Address - Street 1:300 QUAKER LN
Practice Address - Street 2:SUITE 16
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-0159
Practice Address - Country:US
Practice Address - Phone:401-825-7400
Practice Address - Fax:401-284-0625
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A WAKEFIELD WALK IN AND PRIMARY CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00395332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI709006299Medicare PIN