Provider Demographics
NPI:1093736274
Name:NUNNERY ORTHOTIC & PROSTHETIC
Entity Type:Organization
Organization Name:NUNNERY ORTHOTIC & PROSTHETIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHOTIST PROSTHETIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:NUNNERY
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:401-294-4210
Mailing Address - Street 1:7408 POST RD
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-3217
Mailing Address - Country:US
Mailing Address - Phone:401-294-4210
Mailing Address - Fax:401-294-3104
Practice Address - Street 1:7408 POST RD
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-3217
Practice Address - Country:US
Practice Address - Phone:401-294-4210
Practice Address - Fax:401-294-3104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICPO0004335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI22514-8OtherBLUE CROSS BLUE SHIELD
RI401254OtherBLUECHIP
RI5580001Medicaid
RI401254OtherBLUECHIP