Provider Demographics
NPI:1386192037
Name:RHODE ISLAND LIMB CO INC
Entity Type:Organization
Organization Name:RHODE ISLAND LIMB CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:TEOLI
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:401-941-6230
Mailing Address - Street 1:1559 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-3845
Mailing Address - Country:US
Mailing Address - Phone:401-941-6230
Mailing Address - Fax:401-941-6339
Practice Address - Street 1:2850 S COUNTY TRL
Practice Address - Street 2:UNIT 3
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-1748
Practice Address - Country:US
Practice Address - Phone:401-941-6230
Practice Address - Fax:401-941-6339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9009704Medicaid