Provider Demographics
NPI:1699752923
Name:PRIME HEALTHCARE SERVICES LANDMARK LLC
Entity type:Organization
Organization Name:PRIME HEALTHCARE SERVICES LANDMARK LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING ASSOCIATE GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-259-4706
Mailing Address - Street 1:196 CASS AVE
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-4712
Mailing Address - Country:US
Mailing Address - Phone:401-769-4100
Mailing Address - Fax:401-765-6024
Practice Address - Street 1:115 CASS AVE
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-4705
Practice Address - Country:US
Practice Address - Phone:401-769-4100
Practice Address - Fax:401-769-1744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00117282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7029241Medicaid
MA903288OtherTUFTS HEALTH PLAN OUTPT
RI4100011Medicaid
RI222921474OtherTRICARE
MA7000251Medicaid
RI000000001930OtherNEIGHBORHOOD HEALTH PLAN
MA903289OtherTUFTS HEALTH PLAN INPAT.
MA900934OtherHARVARD PILGRIM HEALTH
RIOP00011Medicaid
RI0000000010OtherBLUE CROSS
RI5000704OtherUNITED HEALTHCARE
RIH00104OtherBLUE CHIP
RI222921474OtherTRICARE