1598711004 NPI number — SHAWS SUPERMARKETS INC

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 1598711004 NPI number — SHAWS SUPERMARKETS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHAWS SUPERMARKETS 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:
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:
1598711004
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1925 PAWTUCKET AVE
Provider Second Line Business Mailing Address:
WAMPANOAG MALL
Provider Business Mailing Address City Name:
EAST PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02914-1642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1925 PAWTUCKET AVE
Provider Second Line Business Practice Location Address:
WAMPANOAG MALL
Provider Business Practice Location Address City Name:
EAST PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02914-1642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-435-4950
Provider Business Practice Location Address Fax Number:
401-435-6088
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TORRES
Authorized Official First Name:
LORENZO
Authorized Official Middle Name:
Authorized Official Title or Position:
NEW STORE ENROLLMENTS
Authorized Official Telephone Number:
847-916-4463

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PHA00349 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: SS42593 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4106248 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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