Provider Demographics
NPI:1053432740
Name:PAWTUXET VALLEY FAMILY CARE, LLC
Entity type:Organization
Organization Name:PAWTUXET VALLEY FAMILY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-821-6800
Mailing Address - Street 1:982 TIOGUE AVE
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-6167
Mailing Address - Country:US
Mailing Address - Phone:401-821-6800
Mailing Address - Fax:401-821-8513
Practice Address - Street 1:982 TIOGUE AVE
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-6167
Practice Address - Country:US
Practice Address - Phone:401-821-6800
Practice Address - Fax:401-821-8513
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAWTUXET VALLEY MEDICAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI=========OtherUNITED HEALTH