| NPI | 1972756138 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANCE CLARKE MCCORMACK Member 401-737-4685 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: RI LCDP00439) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: RI LCDP00439) |
| 305R00000X Preferred Provider Organization (Licence: RI LCDP00439) | |
| Enumeration Date | 2008-10-30 |
| Last Update Date | 2008-11-01 |