1194846154 NPI number — FEDERAL HILL PODIATRY GROUP

Table of content: (NPI 1194846154)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194846154 NPI number — FEDERAL HILL PODIATRY GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FEDERAL HILL PODIATRY GROUP
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:
6
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:
1194846154
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 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:
02903-3015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-421-9167
Provider Business Mailing Address Fax Number:
401-421-9193

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 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:
02903-3015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-421-9167
Provider Business Practice Location Address Fax Number:
401-421-9193
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DECESARE
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
401-421-9167

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  DPM00240 , 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: 2343 . This is a "NEIGHBORHOOD J A DECESARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 400515 . This is a "BLUECHIP J A DECESARE DP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 0000007071 . This is a "BCBS RI GROUP ID" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: R003457 . This is a "WPS TRICARE GROUP ID" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 0005779230 . This is a "AETNA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 0137515002 . This is a "CIGNA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 0000007071 . This is a "BLUECHIP GROUP ID" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 0357 . This is a "NEIGHBORHOOD GROUP ID" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: FH00185 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZE5188 . This is a "BCBS MA GROUP ID" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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