Provider Demographics
NPI:1518921816
Name:SOUTH COUNTY ORTHOPEDICS & PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:SOUTH COUNTY ORTHOPEDICS & PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARCHAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-789-1422
Mailing Address - Street 1:1 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3103
Mailing Address - Country:US
Mailing Address - Phone:401-789-1422
Mailing Address - Fax:401-782-6810
Practice Address - Street 1:1 HIGH ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3103
Practice Address - Country:US
Practice Address - Phone:401-789-1422
Practice Address - Fax:401-782-6810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9002536Medicaid
RI9002536Medicaid
RIF02488Medicare UPIN
RIF58817Medicare UPIN
RI209002536Medicare PIN
RII20674Medicare UPIN
RIP70411Medicare UPIN
RIP65288Medicare UPIN
RIC90335Medicare UPIN
RI4472400001Medicare NSC