1376690982 NPI number — ORTHOPEDIC APPLIANCE & BRACE CENTER INC.

Table of content: (NPI 1376690982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376690982 NPI number — ORTHOPEDIC APPLIANCE & BRACE CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDIC APPLIANCE & BRACE CENTER INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1376690982
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
280 BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02903-3007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-331-5548
Provider Business Mailing Address Fax Number:
401-621-8691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
280 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02903-3007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-331-5548
Provider Business Practice Location Address Fax Number:
401-621-8691
Provider Enumeration Date:
01/04/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LONARDO
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
PETER
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
401-331-5548

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  CP00008 , 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: 200837 . This is a "BLUE CHIP OF R.I." identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 2959 . This is a "NEIGHBORHOOD HEALTH OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 9009701 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9701-9 . This is a "BLUE CROSS OF R.I." identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".