1689863474 NPI number — PTW AND CVD ENTERPRISES LLC

Table of content: (NPI 1689863474)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689863474 NPI number — PTW AND CVD ENTERPRISES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PTW AND CVD ENTERPRISES LLC
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:
1689863474
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
544A CHALKSTONE AVE
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:
02908-3618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-569-9488
Provider Business Mailing Address Fax Number:
401-808-6388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
544A CHALKSTONE AVE
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:
02908-3618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-569-9488
Provider Business Practice Location Address Fax Number:
401-808-6388
Provider Enumeration Date:
10/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WONG
Authorized Official First Name:
PHILLIP
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CHIROPRACTIC PHYSICIAN
Authorized Official Telephone Number:
401-569-9488

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DCP00500 , 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: 670397 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 31387 . This is a "BCBSRI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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