PROVIDENCE VAMC (NPI# 1619935145) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619935145 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE VAMC |
| Other Organization Name | PROVIDENCE VAMC PHARMACY |
| Practice Address |
830 Chalkstone Ave Providence RI 02908-4734 |
| Mailing Address |
Po Box 3016 Lebanon PA 17042-3016 |
| Practice Telephone | 4012737100 |
| Practice Fax Number | 4014571421 |
| Mailing Telephone | 7172776565 |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2019-09-05 |
| Authorized Official Name | ERIN DENISE POTTER (NPI TEAM MEMBER) |
| Authorized Official Telephone | 2023822579 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332100000X | Department of Veterans Affairs (VA) Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| RI | NCPDP# | 4106349 | 01 |
| Other Name | Type Code |
|---|---|
| PROVIDENCE VAMC PHARMACY | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710461215 | Providence Vamc | Clinic/Center | 75 Eagle St, Providence, RI 02909-1081 | 2018-09-20 |
| 1902851306 | Providence Vamc | Clinic/Center | 233 Stevens St, Hyannis, MA 02601-3766 | 2006-05-23 |
| 1679971311 | Providence Vamc | Clinic/Center | 623 Atwells Ave, Providence, RI 02909-7403 | 2014-12-11 |
| 1225076664 | Providence Vamc | Clinic/Center | 175 Elm St, New Bedford, MA 02740-6006 | 2006-06-04 |
| 1831136050 | Providence Vamc | Clinic/Center | 1 Corporate Pl, Middletown, RI 02842-6277 | 2006-05-31 |
| 1306896733 | Providence Vamc | General Acute Care Hospital | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2006-05-10 |
| Street Address |
830 CHALKSTONE AVE |
| City | PROVIDENCE |
| State | RI |
| Zip Code | 02908-4734 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174510853 | Frances Ann Bettencourt | Nurse Practitioner | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2005-09-29 |
| 1881295277 | Johnna Bussiere | Nurse's Aide | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2020-11-03 |
| 1770196578 | Caroline Sophie Holman | Psychologist | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2020-08-31 |
| 1104437458 | Vivian Vang | Registered Nurse | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2020-08-11 |
| 1841800604 | Wilcania Baez | Social Worker | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2020-08-06 |
| 1609484757 | Stephen Soonbeom Kwon | Student in an Organized Health Care Education/Training Program | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2020-07-15 |
| 1972111029 | Keenan Sandouk | Student in an Organized Health Care Education/Training Program | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2020-07-15 |
| 1952919011 | Yumna Arif | Student in an Organized Health Care Education/Training Program | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2020-07-15 |
| 1760009518 | Hassan Saada | Nurse Practitioner | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2020-06-28 |
| 1952927675 | Susannah Kondrath | Psychologist | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2020-06-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548771900 | Horizon Wellness | Clinic/Center | 1339 Smith St, North Providence, RI 02908 | 2017-10-12 |
| 1477098069 | Beth Perry | Nurse Practitioner | 830 Chalstone Ave., Providence, RI 02908 | 2017-01-05 |
| 1659788735 | Brandi Kimble | Podiatrist | 825 Chalkstone Avenue, Providence, RI 02908 | 2014-07-21 |
| 1912253675 | Roger Williams Medical Center | Long Term Care Hospital | 25 Chalkstone Ave, Providence, RI 02908 | 2012-07-31 |
| 1669768818 | Elisa Semedo | Physical Therapist | 285 Promenade Street, Providence, RI 02908 | 2011-06-27 |
| 1255655502 | Caregiver Homes of Rhode Island Inc. | Custodial Care Facility | 235 Promenade Street, Providence, RI 02908 | 2010-03-16 |
| 1487884987 | Professional Ambulance LLC | Ambulance | 52 River Ave, Providence, RI 02908 | 2009-07-17 |
| 1609065804 | Stephen W Davis | Family Medicine | 299 Promenade Street, Nhpri, Providence, RI 02908 | 2007-10-24 |
| 1205053899 | John R Ricci | Dentist | 1252 Smith St, Providence, RI 02908 | 2007-04-18 |
| 1871718718 | Brett C Auclaire | Nurse Practitioner | 40 Candace Street, Providence, RI 02908 | 2007-04-16 |
| Find all providers in zip 02908 | ||||
| Taxonomy Code | 332100000X |
| Grouping | Suppliers |
| Classification | Department of Veterans Affairs (VA) Pharmacy |
| Department of Veterans Affairs (VA) Pharmacy means any place under VA jurisdiction where drugs are dispensed and Pharmaceutical Care is provided to enrolled Veterans, by licensed pharmacists. The Pharmacy is reviewed by JCAHO, utilizes the VA hospital’s DEA number, and has a designated NCPDP number. VA facility pharmacies include Inpatient (Institutional), Outpatient, Consolidated Mail Outpatient Pharmacies (CMOPs), Research, Addiction Treatment Centers, Long Term Care and Community Based Outpatient Clinics Pharmacies. The VHA Pharmacy Benefits Management - Strategic Healthcare Group has oversight for professional and practice activities of VA Pharmacies. Each pharmacy is under the direct supervision of a U.S. or U.S. territory licensed pharmacist, and has staffing to meet its designated scope of service. |
| Notes: Source: Pharmacy Benefits Management – Strategic Healthcare Group, Veterans Health Administration, Department of Veterans Affairs [1/1/2006: new] |
| City | PROVIDENCE |
| Zip Code | 02908 |
Please comment or provide details below to improve the information on PROVIDENCE VAMC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.