Basic Information
| Provider Information | |||||||||
| NPI: | 1194830323 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHS VENTURES, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PRIMARY CARE CENTER OF PLAINVILLE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1908 | ||||||||
| Address2: | |||||||||
| City: | PAWTUCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028621908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017292836 | ||||||||
| FaxNumber: | 4017292721 | ||||||||
| Practice Location | |||||||||
| Address1: | 60 MESSENGER ST | ||||||||
| Address2: | |||||||||
| City: | PLAINVILLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027622258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086959933 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2006 | ||||||||
| LastUpdateDate: | 11/30/2007 | ||||||||
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| AuthorizedOfficialLastName: | DIETZ | ||||||||
| AuthorizedOfficialFirstName: | FRANCIS | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4017292130 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 9726284 | 05 | MA | MEDICAID | SH42203 | 05 | RI | MEDICAID |