Organization
NORTHWEST COMMUNITY HEALTH CARE
Active
Other names
WellOne Primary Medical and Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER J. BANCROFT CPA (PRESIDENT & CEO)
(401) 285-5119
Entity
Organization
Contact information
Practice address
308 CALLAHAN RD, N. KINGSTOWN, RI 02852-7739
(401) 295-9706
(401) 295-0920
Mailing address
PO BOX 312, PASCOAG, RI 02859
(401) 568-7664
(401) 285-5101
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
ACF01530
RI
261QC1500X
Community Health Clinic/Center
Primary
ACF01597
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
BS41305
—
RI
05
—
BS41307
—
RI
05
—
NC50602
—
RI
Enumeration date
12/26/2006
Last updated
10/21/2011
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