Hillside Avenue Family and Community Medicine, LLC

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

MD06978 Issued in RI

Legal business name

HILLSIDE AVENUE FAMILY AND COMMUNITY MEDICINE, LLC

Practice address

727 East Ave
Pawtucket, RI 02860-6184

Phone

(401) 724-6160

NPI assigned

Feb 13, 2007

Last updated

Oct 17, 2012By the provider in NPPES

Organization subpart

Yes

Parent organization

MEDVANTX, INC.As reported in NPPES

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

Authorized official

Name

Kenny Heine

Title

Director of Operations

Phone

(858) 625-2990

Specialties & licenses 1

Addresses

Part of

Medvantx Inc

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350432000000",
    "number": "1447392469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "727 EAST AVE",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028606184",
            "telephone_number": "401-724-6160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HILLSIDE AVENUE FAMILY AND COMMUNITY MEDICINE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2007-02-13",
        "last_updated": "2012-10-17",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "RI",
            "license": "MD06978",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alejandra Hernandez
• Kelsey Lynn Hernon, OTR/L
• Christopher P Herzig, D.C.
• Sara Heuser, MSW
• Katina Hilliard
• Hillside Family and Community Medicine, LLC
• Janet Hindley, LICSW/LCDP
• Mara Hochman
• Kyla Hoff
• David Gregory Hogan, LCSW

• Non-Pharmacy Dispensing Site in Pawtucket, RI
• Providers in Pawtucket, RI by specialty
• Non-Pharmacy Dispensing Site in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2012; 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.