| R.i.s.a.t., Llc | |
|
66 Pavilion Ave Providence RI 02905-1522 | |
| (401) 461-9110 | |
| (401) 461-9194 |
| Full Name | R.i.s.a.t., Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 66 Pavilion Ave, Providence, Rhode Island |
| Authorized Official Name and Position | Brian Phillip Farley (VP & SECRETARY) |
| Authorized Official Contact | 6157169335 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| R.i.s.a.t., Llc 6183 Paseo Del Norte Ste 200 Carlsbad CA 92011-1151 Ph: (615) 861-6000 | R.i.s.a.t., Llc 66 Pavilion Ave Providence RI 02905-1522 Ph: (401) 461-9110 |
| NPI Number | 1174521488 |
|---|---|
| Provider Enumeration Date | 07/11/2005 |
| Last Update Date | 04/14/2025 |
| Certification Date | 04/14/2025 |
| Medicare PECOS PAC ID | 7517392053 |
|---|---|
| Medicare Enrollment ID | O20200110001779 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174521488 | NPI | - | NPPES |
| 410268 | Other | RI | BLUECHIP RITECARE |
| 84-10032 | Other | RI | UNITED HEALTHCARE |
| 1017610 | Other | RI | BEACON HEALTH STRATEGIES |
| SP02546 | Medicaid | RI |
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