NPIMap

Organization Active NPI

Providence VA Medical Center

Doing business as Southeastern Psychiatric Associates

  • Adult Mental Health Clinic/Center
  • Providence, RI
National Provider Identifier
1114940681
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
18598 Issued in RI
Legal business name
PROVIDENCE VA MEDICAL CENTER
Doing business as
Southeastern Psychiatric Associates
Practice address
830 Chalkstone Avenue
Providence, RI 02098-4799
Phone
(401) 273-7100
Fax
(401) 457-3354
NPI assigned
Jul 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Allan D. Erickson, MD
Title
Chief Staff
Phone
(401) 273-7100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X 18598 RI Primary

Addresses

Primary practice location

830 Chalkstone Avenue
Providence, RI 02098-4799

Mailing address

830 Chalkstone Avenue
Providence, RI 02098-4799
Phone (401) 273-7100

Other names 1

  • Southeastern Psychiatric Associates Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114940681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 CHALKSTONE AVENUE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "020984799",
            "telephone_number": "401-273-7100",
            "fax_number": "401-457-3354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 CHALKSTONE AVENUE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "020984799",
            "telephone_number": "401-273-7100",
            "fax_number": "401-457-3354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE VA MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ERICKSON",
        "authorized_official_first_name": "ALLAN",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "CHIEF STAFF",
        "authorized_official_telephone_number": "401-273-7100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "RI",
            "license": "18598",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeastern Psychiatric Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Providence, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.