Provider Demographics
NPI:1912253675
Name:ROGER WILLIAMS MEDICAL CENTER
Entity Type:Organization
Organization Name:ROGER WILLIAMS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNAND
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-456-2033
Mailing Address - Street 1:1 REGENCY PLZ
Mailing Address - Street 2:APT612R
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-3158
Mailing Address - Country:US
Mailing Address - Phone:310-593-1523
Mailing Address - Fax:
Practice Address - Street 1:25 CHALKSTONE AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908
Practice Address - Country:US
Practice Address - Phone:401-456-2033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP02653282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital