| Ocean State Primary Care Llc | |
|
300 Toll Gate Rd Ste 202 Warwick RI 02886-4447 | |
| (401) 739-4350 | |
| (401) 739-3759 |
| Full Name | Ocean State Primary Care Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 300 Toll Gate Rd Ste 202, Warwick, Rhode Island |
| Authorized Official Name and Position | Farhat Ibrahim (MD) |
| Authorized Official Contact | 4017394350 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ocean State Primary Care Llc 300 Toll Gate Rd Ste 202 Warwick RI 02886-4447 Ph: (401) 739-4350 | Ocean State Primary Care Llc 300 Toll Gate Rd Ste 202 Warwick RI 02886-4447 Ph: (401) 739-4350 |
| NPI Number | 1548332257 |
|---|---|
| Provider Enumeration Date | 11/15/2006 |
| Last Update Date | 07/22/2021 |
| Medicare PECOS PAC ID | 6305860784 |
|---|---|
| Medicare Enrollment ID | O20060308000022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548332257 | NPI | - | NPPES |
| 404939 | Other | B CHIP | |
| 309562 | Other | BCBS | |
| 400337 | Other | TUFTS | |
| 9004697 | Medicaid | RI | |
| 2499 | Other | NHP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | MD10008 (Rhode Island) | Primary |
| Provider Name | Farhat Ibrahim |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457358442 PECOS PAC ID: 0143285650 Enrollment ID: I20041124000072 |
| Provider Name | Jillian P Clifford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366937849 PECOS PAC ID: 9436494382 Enrollment ID: I20181220001472 |
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