Provider Demographics
NPI:1992840862
Name:ST. JOSEPH HEALTH SERVICES OF RI
Entity type:Organization
Organization Name:ST. JOSEPH HEALTH SERVICES OF RI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOGARTY
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:401-456-3309
Mailing Address - Street 1:200 HIGH SERVICE AVE
Mailing Address - Street 2:4TH FL. MARION HALL
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5113
Mailing Address - Country:US
Mailing Address - Phone:401-456-3309
Mailing Address - Fax:401-456-3762
Practice Address - Street 1:200 HIGH SERVICE AVE
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5113
Practice Address - Country:US
Practice Address - Phone:401-456-3309
Practice Address - Fax:401-456-3762
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST JOSEPH HEALTH SERVICES OF RI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-20
Last Update Date:2010-07-09
Deactivation Date:2007-09-19
Deactivation Code:
Reactivation Date:2009-12-22
Provider Licenses
StateLicense IDTaxonomies
RIHOS00110207ZP0102X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RISJ09278Medicaid
RI229006192Medicare PIN