Provider Demographics
NPI:1881061919
Name:RHODE ISLAND MEDICAL CENTER LLC
Entity type:Organization
Organization Name:RHODE ISLAND MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:E
Authorized Official - Last Name:ISTOMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MS
Authorized Official - Phone:401-622-4488
Mailing Address - Street 1:58 MAIN ST
Mailing Address - Street 2:201
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-3888
Mailing Address - Country:US
Mailing Address - Phone:401-622-4488
Mailing Address - Fax:718-554-1666
Practice Address - Street 1:58 MAIN ST
Practice Address - Street 2:201
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-3888
Practice Address - Country:US
Practice Address - Phone:401-622-4488
Practice Address - Fax:718-554-1666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory