Provider Demographics
NPI:1598724007
Name:SOUTH COUNTY ARTIFICIAL LIMB CO., INC.
Entity Type:Organization
Organization Name:SOUTH COUNTY ARTIFICIAL LIMB CO., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-783-0063
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:WEST KINGSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02892-0176
Mailing Address - Country:US
Mailing Address - Phone:401-783-0063
Mailing Address - Fax:401-789-3190
Practice Address - Street 1:162 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3568
Practice Address - Country:US
Practice Address - Phone:401-783-0063
Practice Address - Fax:401-789-3190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICP00001335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI900-9676Medicaid
RI402559OtherBLUE CHIP OF RI
RI9676-8OtherBC/BS OF RI
RI=========OtherMULTIPLAN NETWORK
RI402559OtherBLUE CHIP OF RI
RI900-9676Medicaid
RI=========OtherNEIGHBORHOOD HEALTH PLAN
RI=========OtherMULTIPLAN NETWORK