1285701847 NPI number — MS. SUSAN L STILL PT

Table of content: MS. SUSAN L STILL PT (NPI 1285701847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285701847 NPI number — MS. SUSAN L STILL PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STILL
Provider First Name:
SUSAN
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMALLSHAW
Provider Other First Name:
SUSAN
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285701847
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3445 POST ROAD
Provider Second Line Business Mailing Address:
J. ARTHUR TRUDEAU MEMORIAL CENTER
Provider Business Mailing Address City Name:
WARWICK
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02886-7147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-739-2700
Provider Business Mailing Address Fax Number:
401-737-8907

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3445 POST ROAD
Provider Second Line Business Practice Location Address:
J. ARTHUR TRUDEAU MEMORIAL CENTER
Provider Business Practice Location Address City Name:
WARWICK
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02886-7147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-739-2700
Provider Business Practice Location Address Fax Number:
401-737-8907
Provider Enumeration Date:
11/29/2006

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: KC02260 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 408253 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 4224 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 6400187 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 233086 . This is a "BC BS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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