Provider Demographics
NPI:1578581443
Name:ST. JOSEPH HEALTH SERVICES OF RHODE ISLAND
Entity type:Organization
Organization Name:ST. JOSEPH HEALTH SERVICES OF RHODE ISLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SNR. VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:CONKLIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:CFO
Authorized Official - Phone:401-456-3000
Mailing Address - Street 1:200 HIGH SERVICE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5113
Mailing Address - Country:US
Mailing Address - Phone:401-456-3000
Mailing Address - Fax:
Practice Address - Street 1:200 HIGH SERVICE AVE
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5113
Practice Address - Country:US
Practice Address - Phone:401-456-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. JOSEPH HEALTH SERVICES OF RHODE ISLAND
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-18
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIHOS00110122300000X, 207N00000X, 207R00000X, 207RC0000X, 207RC0001X, 207RP1001X, 207V00000X, 207ZP0102X, 2084N0400X, 282N00000X
RIHOS0110208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RISJ09278Medicaid
RISJ09331Medicaid
RISJ09268Medicaid
RISJ48636Medicaid
RISJ09267Medicaid
RISJ13504Medicaid
RISJ47734Medicaid
RISJ09285Medicaid
RISJ09289Medicaid
RISJ09459Medicaid
RISJ09285Medicaid
RISJ09289Medicaid
RI709006124Medicare PIN
RISJ09459Medicaid
RISJ09331Medicaid
RI139006120Medicare PIN
RI410005Medicare Oscar/Certification
RI509025253Medicare PIN