# OCEAN STATE PRIMARY CARE CENTER OF WESTERLY, LLC

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

## Provider details

- **NPI number:** 1265857007
- **Authorized official:** MR. JONATHAN HAMILTON MARTIN MD (OWNER/PHYSICIAN)
- **Authorized official phone:** (401) 596-6464

## Contact information

- **Practice address:** 77 FRANKLIN STREET, WESTERLY, RI 02891
- **Practice address phone:** (401) 596-6464
- **Practice address fax:** (401) 348-8660
- **Mailing address:** 77 FRANKLIN STREET, WESTERLY, RI 02891
- **Mailing address phone:** (401) 596-6464
- **Mailing address fax:** (401) 348-8660

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/04/2014
- **Last updated:** 05/20/2014