Provider Demographics
NPI:1861530354
Name:OCEAN STATE HEALTH CARE CLINICS, INC.
Entity type:Organization
Organization Name:OCEAN STATE HEALTH CARE CLINICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GOPALA
Authorized Official - Middle Name:
Authorized Official - Last Name:VASUDEVAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:401-742-3427
Mailing Address - Street 1:20 CUMBERLAND HILL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-4854
Mailing Address - Country:US
Mailing Address - Phone:401-765-2250
Mailing Address - Fax:401-766-6588
Practice Address - Street 1:20 CUMBERLAND HILL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-4854
Practice Address - Country:US
Practice Address - Phone:401-765-2250
Practice Address - Fax:401-766-6588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIOS27487Medicaid