Organization
ST. JOSEPH HEALTH SERVICES OF RI
Active
Organization
ST. JOSEPH HEALTH SERVICES OF RI
Active
Parent organization
ST JOSEPH HEALTH SERVICES OF RI
Other names
ADULT PRIMARY CARE
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST JOSEPH HEALTH SERVICES OF RI
Authorized official
MICHAEL CONKLIN CFO (SNR. VISE PRESIDENT)
(401) 456-2525
Entity
Organization
Contact information
Practice address
21 PEACE ST, PROVIDENCE, RI 02907-1510
(401) 456-4325
(401) 456-4250
Mailing address
200 HIGH SERVICE AVE, ATTN: ROSE SOARES, NORTH PROVIDENCE, RI 02904-5113
(401) 456-2525
(401) 456-6742
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
HOS00110
RI
207R00000X
Internal Medicine Physician
Primary
HOS00110
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
509025253
MEDICARE P-TAN
RI
05
—
SJ48636
—
RI
Enumeration date
02/20/2007
Last updated
01/25/2013
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