Basic Information
| Provider Information | |||||||||
| NPI: | 1306034244 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SILVER SPRING HEALTH CARE MANAGEMENT, INC | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 100 KENYON AVE | ||||||||
| Address2: | |||||||||
| City: | WAKEFIELD | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028794216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017883929 | ||||||||
| FaxNumber: | 4017883939 | ||||||||
| Practice Location | |||||||||
| Address1: | 70 KENYON AVE STE L10 | ||||||||
| Address2: | |||||||||
| City: | WAKEFIELD | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028794239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017881638 | ||||||||
| FaxNumber: | 4017829892 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2007 | ||||||||
| LastUpdateDate: | 05/17/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/18/2019 | ||||||||
| NPIReactivationDate: | 03/27/2019 | ||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | POLHEMUS | ||||||||
| AuthorizedOfficialFirstName: | MARCIA | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 4017881974 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD07065 | RI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | MD07065 | 01 | RI | LICENSE | OTHER | NPP37418 | 01 | RI | RI MEDICAL LICENSE | OTHER |