1548227200 NPI number — WILLIAM J POIRIER PT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548227200 NPI number — WILLIAM J POIRIER PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POIRIER
Provider First Name:
WILLIAM
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

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:
1548227200
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1181 AQUIDNECK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02842-5255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-845-0840
Provider Business Mailing Address Fax Number:
401-619-3752

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1808 MAIN 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:
02878-4625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-625-1539
Provider Business Practice Location Address Fax Number:
401-625-9856
Provider Enumeration Date:
04/27/2006

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: 225100000X , with the licence number:  PT00599 , 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: PT00599 . This is a "TRI-CARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 64-00296 . This is a "UNITED HEALTH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 402473 . This is a "BLUE CHIP RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 22645-3 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 13859 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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