1972680189 NPI number — MRS. CYNTHIA ANNE BUXTON MS RD LDN CDOE CLC

Table of content: MRS. CYNTHIA ANNE BUXTON MS RD LDN CDOE CLC (NPI 1972680189)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972680189 NPI number — MRS. CYNTHIA ANNE BUXTON MS RD LDN CDOE CLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUXTON
Provider First Name:
CYNTHIA
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS RD LDN CDOE CLC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PRATT
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972680189
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
49 OLD PINE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NARRAGANSETT
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02882-2406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-789-3744
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 RIVER ST
Provider Second Line Business Practice Location Address:
THUNDER MIST HEALTH CENTER OF SOUTH COUNTY
Provider Business Practice Location Address City Name:
WAKEFIELD
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-783-0523
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2006

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: 133V00000X , with the licence number:  LDN00157 , 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: 292793 . This is a "BLUE CROSS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 28981 . This is a "NEIGHBORHOOD HEALTH C" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 6300302 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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