Ocean State Medical, LLC

Organization Active NPI Non-Pharmacy Dispensing Site · Johnston, RI

NPI 1386787232 · NPPES record last updated Oct 17, 2012

Key facts

NPI
1386787232
Entity type
Organization (NPI type 2)
Primary specialty
Non-Pharmacy Dispensing Site 332900000X
License
MD06856 (RI)
Legal business name
OCEAN STATE MEDICAL, LLC
Practice address
1539 Atwood Ave
Suite 101
Johnston, RI 02919-3262
Phone
(401) 272-3410
NPI assigned
Feb 14, 2007
Organization subpart
Yes
Parent organization (as reported)
MEDVANTX,INC

Authorized official

Name
Kenny Heine
Title
Director of Operations
Phone
(858) 625-2990

Corporate family (same tax ID) 13

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

Practitioners 5

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

National Provider Directory

Tax ID family
Lynn a Haughey NPP (14 organizations share this tax ID)
Part of
Tri - State Medical Group Inc

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X MD06856 RI Yes

Addresses

Primary practice location

1539 Atwood Ave
Suite 101
Johnston, RI 02919-3262

Mailing address

5626 Oberlin Dr
Suite 110
San Diego, CA 92121-1705

Other providers in Johnston, RI

All providers in Johnston, RI · Non-Pharmacy Dispensing Site in Rhode Island

Sources for this page

Verify at the official NPI Registry.