Provider Demographics
NPI:1831450865
Name:ST JOSEPH HEALTH SERVICES OF RI
Entity type:Organization
Organization Name:ST JOSEPH HEALTH SERVICES OF RI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SNR. VICE PRESIDENT, CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:CONKLIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:401-456-3000
Mailing Address - Street 1:200 HIGH SERVICE AVE
Mailing Address - Street 2:ADMINISTRATION OFFICE, ATTN: R. SOARES
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5113
Mailing Address - Country:US
Mailing Address - Phone:401-456-2525
Mailing Address - Fax:401-456-6742
Practice Address - Street 1:200 HIGH SERVICE AVE
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5113
Practice Address - Country:US
Practice Address - Phone:401-456-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIHOS00110207P00000X, 207R00000X, 207RG0300X
RIHO00110208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIHOS00110OtherHOSPITAL LICENSE NUMBER