Provider Demographics
NPI:1801680004
Name:MDRI LLC
Entity type:Organization
Organization Name:MDRI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DESIREE COFFEY
Authorized Official - Middle Name:
Authorized Official - Last Name:COFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-398-0288
Mailing Address - Street 1:1407 S COUNTY TRL STE 431
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1679
Mailing Address - Country:US
Mailing Address - Phone:401-398-0288
Mailing Address - Fax:401-398-0288
Practice Address - Street 1:1239 HARTFORD AVE STE 3
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-7137
Practice Address - Country:US
Practice Address - Phone:401-398-0288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care