1780748806 NPI number — NORTH SMITHFIELD PODIATRY INC

Table of content: (NPI 1780748806)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780748806 NPI number — NORTH SMITHFIELD PODIATRY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH SMITHFIELD PODIATRY 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:
1780748806
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
249 EDDIE DOWLING HIGHWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH SMITHFIELD
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02896
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-769-5611
Provider Business Mailing Address Fax Number:
401-769-6238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
249 EDDIE DOWLING HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH SMITHFIELD
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02896
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-769-5611
Provider Business Practice Location Address Fax Number:
401-769-6238
Provider Enumeration Date:
12/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SULLIVAN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PODIATRIST OWNER
Authorized Official Telephone Number:
401-769-5611

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  DPM , 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: 9007057 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2700284 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 480021635 . This is a "RAILROAD MED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000262 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0005952117 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 33235 . This is a "HARVARD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 004962 . This is a "BLUE CHIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1506 . This is a "NEIGHBORHOOD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000917250002 . This is a "AARP MED" identifier . This identifiers is of the category "OTHER".




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