1801954847 NPI number — TERRI BELANGER PCNS

Table of content: TERRI BELANGER PCNS (NPI 1801954847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801954847 NPI number — TERRI BELANGER PCNS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELANGER
Provider First Name:
TERRI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PCNS
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:
1801954847
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
48 TURNER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST WARWICK
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02893-5428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-331-1350
Provider Business Mailing Address Fax Number:
401-277-3366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
345 BLACKSTONE BLVD
Provider Second Line Business Practice Location Address:
ANNEX BLDG, RM 232
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02906-4800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-370-3651
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/04/2006

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: 163W00000X , with the licence number:  RN25557 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0808X , with the licence number: PPNS00063 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0809X , with the licence number: PPNS00063 , 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: 29111-6 . This is a "BLUE CROSS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 12378202 . This is a "MULTI-PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 412625 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 62-46938 . This is a "UNITED BEHAVIROAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: TB06857 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1021740 . This is a "NHP-GROUP NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 103098500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com