Organization
WICKFORD FAMILY MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN MACHATA M.D. (MEDICAL DIRECTOR)
(401) 450-2111
Entity
Organization
Contact information
Practice address
320 PHILLIPS ST, SUITE 204, NORTH KINGSTOWN, RI 02852-5149
(401) 450-2111
Mailing address
PO BOX 118, NORTH KINGSTOWN, RI 02852-0118
(401) 450-2111
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
08781
RI
Other
Enumeration date
03/07/2011
Last updated
03/07/2011
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