Basic Information
| Provider Information | |||||||||
| NPI: | 1487664504 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JACQUELINE ANNE SILVA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 NEWMAN AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | RUMFORD | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029161945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014530666 | ||||||||
| FaxNumber: | 4014539619 | ||||||||
| Practice Location | |||||||||
| Address1: | 960 BOSTON NECK RD | ||||||||
| Address2: | |||||||||
| City: | NARRAGANSETT | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028821714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017921199 | ||||||||
| FaxNumber: | 4017920011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 05/15/2008 | ||||||||
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| AuthorizedOfficialLastName: | SILVA | ||||||||
| AuthorizedOfficialFirstName: | JACQUELINE | ||||||||
| AuthorizedOfficialMiddleName: | ANNE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4017920011 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.