NPIMap

Organization Active NPI

Pawtuxet Valley Prescription & Surgical Center,Inc

  • Home Infusion Therapy Pharmacy
  • Coventry, RI
National Provider Identifier
1437282886
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Infusion Therapy PharmacyTaxonomy code 3336H0001X
License
PHA00010 Issued in RI
Legal business name
PAWTUXET VALLEY PRESCRIPTION & SURGICAL CENTER,INC
Practice address
85 Sandy Bottom Rd
Coventry, RI 02816-5863
Phone
(401) 821-0600
Fax
(401) 823-7558
NPI assigned
Mar 14, 2007
Last updated
Mar 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Mr. Mark Gilmore, RPH
Title
Director of Operations
Phone
(401) 821-0600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Infusion Therapy Pharmacy 3336H0001X PHA00010 RI Primary

Addresses

Primary practice location

85 Sandy Bottom Rd
Coventry, RI 02816-5863

Mailing address

85 Sandy Bottom Rd
Coventry, RI 02816-5863
Phone (401) 821-0600

Other identifiers 5

IdentifierTypeStateIssuer
4104989OtherRINABP #
58225OtherRIBLUE CROSS #
PV52305MedicaidRI
PV07288MedicaidRI
PV05379MedicaidRI

Other names 1

  • Pawtuxet Valley InfusionCare Other name

National Provider Directory

National Provider Directory
Tax ID family
Pawtuxet Valley Compound Lab5 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.

Locations

85 Sandy Bottom Rd
Coventry, RI 02816
Phone (401) 821-0600

Practitioners & affiliated clinicians

Practitioners 10

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": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1437282886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 SANDY BOTTOM RD",
            "city": "COVENTRY",
            "state": "RI",
            "postal_code": "028165863",
            "telephone_number": "401-821-0600",
            "fax_number": "401-823-7558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 SANDY BOTTOM RD",
            "city": "COVENTRY",
            "state": "RI",
            "postal_code": "028165863",
            "telephone_number": "401-821-0600",
            "fax_number": "401-823-7558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAWTUXET VALLEY PRESCRIPTION & SURGICAL CENTER,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "GILMORE",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "401-821-0600",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": "RI",
            "license": "PHA00010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP #",
            "identifier": "4104989",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS #",
            "identifier": "58225",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PV52305",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PV07288",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PV05379",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pawtuxet Valley InfusionCare",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Coventry, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.