NPIMap

Organization Active NPI

Memorial Hospital

  • Clinical Pathology/Laboratory Medicine Physician
  • Pawtucket, RI
National Provider Identifier
1194945980
Registry record updated Nov 30, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Pathology/Laboratory Medicine PhysicianTaxonomy code 207ZP0105X
Legal business name
MEMORIAL HOSPITAL
Practice address
111 Brewster St
Pawtucket, RI 02860-4400
Phone
(401) 729-2000
NPI assigned
Apr 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2007

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

Authorized official

Name
Mr. Francis R Dietz
Title
Ceo President
Phone
(401) 729-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Pathology/Laboratory Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ZP0105X Primary

Addresses

Primary practice location

111 Brewster St
Pawtucket, RI 02860-4400

Mailing address

111 Brewster St
Pawtucket, RI 02860-4400
Phone (401) 729-2000

Other identifiers 1

IdentifierTypeStateIssuer
9006182MedicaidRI

Other names 1

  • Memorial Hospital Pathology Group Other name

National Provider Directory

National Provider Directory
Tax ID family
John P Cooke PA C5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196380800000",
    "number": "1194945980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 BREWSTER ST",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028604400",
            "telephone_number": "401-729-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 BREWSTER ST",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028604400",
            "telephone_number": "401-729-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-26",
        "last_updated": "2007-11-30",
        "status": "A",
        "authorized_official_last_name": "DIETZ",
        "authorized_official_first_name": "FRANCIS",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO PRESIDENT",
        "authorized_official_telephone_number": "401-729-2000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207ZP0105X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Clinical Pathology/Laboratory Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9006182",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memorial Hospital Pathology Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Pawtucket, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2007; 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.