# ROGER WILLIAMS MEDICAL CENTER

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

## Provider details

- **NPI number:** 1205563731
- **Authorized official:** CYNTHIA BOUTIN (COORDINATOR)
- **Authorized official phone:** (401) 456-2070

## Contact information

- **Practice address:** 825 CHALKSTONE AVE, PROVIDENCE, RI 02908-4728
- **Practice address phone:** (401) 456-2000
- **Mailing address:** 825 CHALKSTONE AVE, PROVIDENCE, RI 02908-4728

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/04/2022
- **Last updated:** 08/04/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | LP05722 | STATE OF RHODE ISLAND DEPARTMENT OF HEALTH | RI |