Provider Demographics
NPI:1619224789
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:VICE 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:
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 1:59 PROSPECT ST
Practice Address - Street 2:SUITE B
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4482
Practice Address - Country:US
Practice Address - Phone:401-475-3501
Practice Address - Fax:401-475-3516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICP00009335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9009704Medicaid