Organization
UNIVERSITY MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRACY WALLACE (CEO)
(401) 456-2717
Entity
Organization
Contact information
Practice address
50 MAUDE ST, PROVIDENCE, RI 02908-4325
(401) 456-5368
Mailing address
825 CHALKSTONE AVE, PROVIDENCE, RI 02908-4728
(401) 456-2717
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
UM 24173
—
RI
Enumeration date
06/24/2006
Last updated
08/22/2020
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