MR. JACK H KLIE (NPI# 1992876080) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992876080 |
| Entity Type | Individual |
| Full Name | MR. JACK H KLIE |
| Credential | MD |
| Practice Address |
1 Randall Sq Suite 305 Providence RI 02904-2709 |
| Practice Telephone | 4015210700 |
| Practice Fax Number | 4015210906 |
| Mailing Telephone | 4015210700 |
| Mailing Fax Number | 4015210906 |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2009-03-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
4568 | RI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| RI | 9000849 | 05 | |
| RI | BLUE CHIP | 001218 | 01 |
| RI | BLUE CROSS | 849 | 01 |
| Street Address |
1 RANDALL SQ SUITE 305 |
| City | PROVIDENCE |
| State | RI |
| Zip Code | 02904-2709 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629074752 | Magdalena G Krzystolik | Ophthalmology | 1 Randall Sq, Suite 203, Providence, RI 02904-2709 | 2005-06-23 |
| 1366051849 | Caroline S. Murray | Nurse Practitioner | 1 Randall Sq, Providence, RI 02904-2709 | 2020-07-30 |
| 1134744659 | Briana J. Bartone | Nurse Practitioner | 1 Randall Sq, Providence, RI 02904-2709 | 2020-06-10 |
| 1639717408 | Kaleena Crooks | Registered Nurse | 1 Randall Sq, Providence, RI 02904-2709 | 2019-12-12 |
| 1922657907 | Catherine Putko | Nurse Practitioner | 1 Randall Sq, Providence, RI 02904-2709 | 2019-09-11 |
| 1003383795 | Phina A Mayu | Nurse Practitioner | 1 Randall Sq, Providence, RI 02904-2709 | 2018-10-31 |
| 1982185526 | Takeysha A Duarte | Nurse Practitioner | 1 Randall Sq, Providence, RI 02904-2709 | 2018-08-22 |
| 1184104648 | Bridget M Andaloro | Nurse Practitioner | 1 Randall Sq, Providence, RI 02904-2709 | 2018-08-15 |
| 1649788258 | Caroline Miringu-ruitha | Nurse Practitioner | 1 Randall Sq, Providence, RI 02904-2709 | 2018-01-17 |
| 1083138572 | The Providence Community Health Centers, Inc | Clinic/Center | 1 Randall Sq, Providence, RI 02904-2709 | 2017-07-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144792383 | Lifespan Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 180 Corliss Street, Suite A, Providence, RI 02904 | 2018-12-28 |
| 1780168229 | Beth M. Kalunian | Social Worker | 480 Charles Street, Providence, RI 02904 | 2018-09-20 |
| 1588161608 | Michael P. Johnson, Md, Inc | Internal Medicine | 148 W River St Ste 22b, Providence, RI 02904 | 2018-04-06 |
| 1780045948 | Fred Saccoccio | Pharmacist | 15 Smithfield Road, No Providence, RI 02904 | 2016-03-16 |
| 1699148999 | Latin Adult Day Health Care Center | Clinic/Center | 665 Charles Street, Providence, RI 02904 | 2015-11-09 |
| 1144639956 | Dina P Toolin | Occupational Therapist | 195 Collyer St. 3rd Floor, University Medical Center/miriam Hospital Outpatient, Providence, RI 02904 | 2014-08-06 |
| 1801208798 | Seth Clark | Internal Medicine | 200 Corliss St, Providence, RI 02904 | 2014-05-27 |
| 1134554645 | Molly Elizabeth Smith | Physical Therapist | 1405 Douglas Ave, North Providence, RI 02904 | 2013-09-04 |
| 1336408723 | Emad Awa | Pediatrics | 1 Randall Sq Ste 404, Providence, RI 02904 | 2012-05-07 |
| 1598036790 | Joseph F. Osmanski, Od, Inc | Optometrist | 1971 Mineral Spring Avenue, N. Providence, RI 02904 | 2012-01-19 |
| Find all providers in zip 02904 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265621460 | Gideon Koren | Internal Medicine | Rih, 1 Hoppin Street, Providence, RI 02903 | 2007-10-24 |
| 1003921693 | Mario Tami | Internal Medicine | 1264 Smith St, Providence, RI 02908 | 2006-08-21 |
| 1548295942 | Harry Schwartz | Internal Medicine | 208 Collyer Street, Suite 100, Providence, RI 02904 | 2006-07-12 |
| 1548221831 | Youssef H Georgy | Internal Medicine | 30 Blackstone Blvd, Providence, RI 02906-5445 | 2006-03-28 |
| 1629076351 | Gisele Saliba | Internal Medicine | 1524 Atwood Ave, Providence, RI 02919-3228 | 2005-07-07 |
| 1952306185 | Mitchel A Sklar | Internal Medicine | 593 Eddy St, Providence, RI 02903-4923 | 2005-06-15 |
| 1497759294 | Franklin Schneider | Internal Medicine | 1076 North Main Street, Providence, RI 02904 | 2005-06-09 |
| 1730612490 | Pieter Storm De Klerk | Internal Medicine | 593 Eddy St, Providence, RI 02903-4923 | 2017-04-09 |
| 1881135051 | Cara Guardino | Internal Medicine | 593 Eddy St, Providence, RI 02903-4923 | 2017-03-20 |
| 1588088850 | The Miriam Hospital | Internal Medicine | 164 Summit Ave, Fain Bldg, Providence, RI 02906-2853 | 2014-02-07 |
| Find all providers in PROVIDENCE | ||||
| City | PROVIDENCE |
| Zip Code | 02904 |
Please comment or provide details below to improve the information on MR. JACK H KLIE.
| 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.