# WICKFORD FAMILY MEDICINE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104124734
- **Authorized official:** JOHN MACHATA M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (401) 450-2111

## Contact information

- **Practice address:** 320 PHILLIPS ST, SUITE 204, NORTH KINGSTOWN, RI 02852-5149
- **Practice address phone:** (401) 450-2111
- **Mailing address:** PO BOX 118, NORTH KINGSTOWN, RI 02852-0118
- **Mailing address phone:** (401) 450-2111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 08781 | RI | Yes |

## Other

- **Enumeration date:** 03/07/2011
- **Last updated:** 03/07/2011