Providence Interventional Associates II LLC

Primary specialty

Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X

Legal business name

PROVIDENCE INTERVENTIONAL ASSOCIATES II LLC

Practice address

100 Highland Ave Ste 100
Providence, RI 02906-2740

Phone

(401) 277-9729

Fax

(401) 277-9730

NPI assigned

Nov 3, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Jonah Licht, M.D.NPI 1134192891

Title

Owner

Phone

(401) 277-9729

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in RI

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Providence Interventional Associates II LLC

  • Ambulatory Surgical Clinic/Center
  • Providence, RI
  • NPI 1497220412

  6204094212

  Same PAC ID

Tax ID family

Providence Access Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Providence Interventional Associates II LLC

  • Ambulatory Surgical Clinic/Center
  • Providence, RI
  • NPI 1497220412
  NPD tax ID

Locations

Practitioners 1

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

• Jonah M Licht, MD

  • Nephrology Physician
  • Providence, RI
  • NPI 1134192891
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1320278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749772800000",
    "number": "1306123476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 HIGHLAND AVE STE 100",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029062740",
            "telephone_number": "401-277-9729",
            "fax_number": "401-277-9730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HIGHLAND AVE STE 100",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029062740",
            "telephone_number": "401-277-9729",
            "fax_number": "401-277-9730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE INTERVENTIONAL ASSOCIATES II LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-03",
        "last_updated": "2025-06-13",
        "certification_date": "2025-06-13",
        "status": "A",
        "authorized_official_last_name": "LICHT",
        "authorized_official_first_name": "JONAH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "401-277-9729",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PR86788",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Providence Dental Group, LLC
• Providence Dental PC
• Providence Dental Sleep Center LLC
• Providence Eye Associates, Inc.
• Providence Integrative Wellness
• Providence Interventional Associates II LLC
• Providence Medical Healthcare Center
• Providence Medical Supplies
• Providence Metro Treatment Center
• Providence Nutrition, LLC

• Vascular & Interventional Radiology Physician in Providence, RI
• Providers in Providence, RI by specialty
• Vascular & Interventional Radiology Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.