Organization
PAWTUXET VALLEY PRESCRIPTION & SURGICAL CENTER,INC
Active
Other names
Pawtuxet Valley IDME
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK GILMORE RPH (DIRECTOR OF OPERATIONS)
(401) 821-0600
Entity
Organization
Contact information
Practice address
59 SANDY BOTTOM RD, COVENTRY, RI 02816-5863
(401) 821-5000
(401) 821-5016
Mailing address
59 SANDY BOTTOM RD, COVENTRY, RI 02816-5863
(401) 821-5000
(401) 821-5016
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
PHA00001
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
75763
BLUE CROSS #
RI
05
—
9010107
—
RI
Enumeration date
03/14/2007
Last updated
09/29/2008
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