Basic Information
| Provider Information | |||||||||
| NPI: | 1518907302 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPECTRUM FAMILY HEALTH INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 ORMS ST | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029042228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014530666 | ||||||||
| FaxNumber: | 4014539619 | ||||||||
| Practice Location | |||||||||
| Address1: | 541 NEWPORT AVE | ||||||||
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| City: | PAWTUCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028613624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014754588 | ||||||||
| FaxNumber: | 4014754589 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GARG | ||||||||
| AuthorizedOfficialFirstName: | MANOJ | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4014754588 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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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 |
No ID Information.