1801907571 NPI number — MRS. SHARON T RUST LICWS

Table of content: MRS. SHARON T RUST LICWS (NPI 1801907571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801907571 NPI number — MRS. SHARON T RUST LICWS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUST
Provider First Name:
SHARON
Provider Middle Name:
T
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LICWS
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:
1801907571
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
87 BISMARK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TIVERTON
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02878-2034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-207-4316
Provider Business Mailing Address Fax Number:
401-375-5224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 NECK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TIVERTON
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02878-4010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-207-4316
Provider Business Practice Location Address Fax Number:
401-207-4316
Provider Enumeration Date:
08/31/2006

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: 1041C0700X , with the licence number:  ISW 01229 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 340648 . This is a "TRI-CARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1021100 . This is a "NHP - GROUP NUMBER" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 406910 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 30641-2 . This is a "BLUE CROSS/ BLUE SHIELD" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 311822 . This is a "MAGELLAN- GROUP NUMBER" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 62-27979 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: SR31997 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




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