Basic Information
| Provider Information | |||||||||
| NPI: | 1053443911 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHAD BROWN HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 ORMS ST STE 110 | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029047814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014530666 | ||||||||
| FaxNumber: | 4014539619 | ||||||||
| Practice Location | |||||||||
| Address1: | 285A CHAD BROWN ST | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029083102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012746339 | ||||||||
| FaxNumber: | 4014536290 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CLANCY | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
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| AuthorizedOfficialTitleorPosition: | FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 4012746339 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 451-2 | 01 | RI | GROUP BS NUMBER | OTHER | 9000451 | 05 | RI | MEDICAID | 0181 | 01 | RI | NEIBORHOOD HEALTH GROUP | OTHER |