Provider Demographics
NPI:1336226125
Name:COVENTRY IMAGING ASSOC LLC
Entity type:Organization
Organization Name:COVENTRY IMAGING ASSOC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-822-8700
Mailing Address - Street 1:71 SANDY BOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-5863
Mailing Address - Country:US
Mailing Address - Phone:401-822-0300
Mailing Address - Fax:401-822-8701
Practice Address - Street 1:71 SANDY BOTTOM RD
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-5863
Practice Address - Country:US
Practice Address - Phone:401-822-0300
Practice Address - Fax:401-822-8701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9004730Medicaid
RI709004730Medicare PIN