Organization
PROSPECT CHARTERCARE RWMC, LLC
Active
Other names
Roger Williams Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT JON ELDERS (SECRETARY)
(714) 788-1249
Entity
Organization
Contact information
Practice address
825 CHALKSTONE AVE, PROVIDENCE, RI 02908-4728
(401) 456-2000
(401) 456-2029
Mailing address
825 CHALKSTONE AVE, PROVIDENCE, RI 02908-4728
(401) 456-2000
(401) 456-2029
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
HOS00108
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4100004
—
RI
01
—
999990000/12115 NOCD
CHAMP VA
RI
01
—
CA 2157
RAILROAD MEDICARE
RI
05
—
OP00004
—
RI
Enumeration date
02/27/2014
Last updated
01/11/2021
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