1669417077 NPI number — JUDITH ASHWORTH PCNS

Table of content: JUDITH ASHWORTH PCNS (NPI 1669417077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669417077 NPI number — JUDITH ASHWORTH PCNS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ASHWORTH
Provider First Name:
JUDITH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PCNS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669417077
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 COLLEGE HILL RD
Provider Second Line Business Mailing Address:
BLDG 29
Provider Business Mailing Address City Name:
WARWICK
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02886-2776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-822-4673
Provider Business Mailing Address Fax Number:
401-822-4676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 COLLEGE HILL RD
Provider Second Line Business Practice Location Address:
BLDG 29
Provider Business Practice Location Address City Name:
WARWICK
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02886-2776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-822-4673
Provider Business Practice Location Address Fax Number:
401-822-4676
Provider Enumeration Date:
06/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WP0808X , with the licence number:  RN14141 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 364SP0809X , with the licence number: APRN00187 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0808X , with the licence number: CAPRN00187 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: BLK31 . This is a "GIC" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 410930 . This is a "BLUE CROSS OF IL" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 26721-4 . This is a "BLUECROSS & BLUE SHIELD" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 05-0468084 . This is a "UNITED HEALTH PLANS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 410930 . This is a "COORDINATED HEALTH PLANS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".