Organization
STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
Active
Other names
Department of Health
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS A AXELSEN (CFO)
(401) 222-5112
Entity
Organization
Contact information
Practice address
3 CAPITOL HL, ROOM 402, PROVIDENCE, RI 02908-5034
(401) 222-5112
(401) 222-1256
Mailing address
3 CAPITOL HL, ROOM 402, PROVIDENCE, RI 02908-5034
(401) 222-5112
(401) 222-1256
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000031189
BLUE CROSS PROVIDER NUMBR
RI
Enumeration date
03/15/2007
Last updated
10/17/2011
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