Provider Demographics
NPI:1427269265
Name:MIRIAM HOSPITAL
Entity type:Organization
Organization Name:MIRIAM HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP, FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-444-7914
Mailing Address - Street 1:1 HOPPIN ST
Mailing Address - Street 2:CORO BLDG., BEHAVIORAL AND PREVENTIVE MEDICINESUITE 500
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4141
Mailing Address - Country:US
Mailing Address - Phone:401-793-8230
Mailing Address - Fax:401-793-8078
Practice Address - Street 1:1 HOPPIN ST
Practice Address - Street 2:CORO BLDG., BEHAVIORAL MEDICINE CLINIC
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4141
Practice Address - Country:US
Practice Address - Phone:401-793-8230
Practice Address - Fax:401-793-8078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI507103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty