Basic Information
| Provider Information | |||||||||
| NPI: | 1023369485 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OCEAN STATE CARDIOVASCULAR AND VEIN CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 68 | ||||||||
| Address2: | |||||||||
| City: | OSCEOLA MILLS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166660068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143397101 | ||||||||
| FaxNumber: | 8143396165 | ||||||||
| Practice Location | |||||||||
| Address1: | 191 SOCIAL ST | ||||||||
| Address2: | |||||||||
| City: | WOONSOCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028953240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022338759 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2012 | ||||||||
| LastUpdateDate: | 09/27/2012 | ||||||||
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| AuthorizedOfficialLastName: | SABER | ||||||||
| AuthorizedOfficialFirstName: | WALID | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8022338759 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.