| Chan Park Md Inc | |
|
905 Victory Highway Slatersville RI 02876 | |
| (401) 762-2728 | |
| (401) 762-0473 |
| Full Name | Chan Park Md Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 905 Victory Highway, Slatersville, Rhode Island |
| Authorized Official Name and Position | Chan Hoon Park (OWNER) |
| Authorized Official Contact | 4017622728 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Chan Park Md Inc Po Box 177 905 Victory Hwy Slatersville RI 02876 Ph: (401) 762-2728 | Chan Park Md Inc 905 Victory Highway Slatersville RI 02876 Ph: (401) 762-2728 |
| NPI Number | 1104865849 |
|---|---|
| Provider Enumeration Date | 06/06/2006 |
| Last Update Date | 02/26/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104865849 | NPI | - | NPPES |
| 12601 | Other | RI | BLUE CROSS BLUE SHIELD |
| 9001260 | Medicaid | RI | |
| 001727 | Other | RI | BCBS BLUE CHIP |
| 404332 | Other | TUFTS | |
| AA26737 | Other | HAVARD PILGRIM | |
| 0101561 | Other | MA | EVERCARE |
| 0100118 | Other | UNITED HEALTHCARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MD5083 (Rhode Island) | Primary |