Provider Demographics
NPI:1316060171
Name:THE MIRIAM HOSPITAL
Entity type:Organization
Organization Name:THE MIRIAM HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:E VP & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:K
Authorized Official - Last Name:MARKELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-444-7914
Mailing Address - Street 1:117 ELLENFIELD ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4513
Mailing Address - Country:US
Mailing Address - Phone:401-444-5640
Mailing Address - Fax:401-444-5462
Practice Address - Street 1:164 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2853
Practice Address - Country:US
Practice Address - Phone:401-444-8344
Practice Address - Fax:401-444-7870
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFESPAN CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-09
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIHOS00122246XC2901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XC2901XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularCardiovascular Invasive SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI709006147Medicare ID - Type UnspecifiedMEDI PART B GRPPIN NUMBER