1710078712 NPI number — FOOT HEALTH INC

Table of content: (NPI 1710078712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710078712 NPI number — FOOT HEALTH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOT HEALTH 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:
1710078712
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 NEWMAN AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
RUMFORD
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02916
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:
164 DURFEE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FALL RIVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-674-1400
Provider Business Practice Location Address Fax Number:
508-673-2146
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TAITZ
Authorized Official First Name:
MARSHALL
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
DPM
Authorized Official Telephone Number:
508-674-1400

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  MA1574 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001574 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1819138 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 5819 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 402653 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 7072 . This is a "BLUE CROSS OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 33034 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9778594 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: Y77154 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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