Provider Demographics
NPI:1679840342
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:
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 1:16 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:PAWCATUCK
Practice Address - State:CT
Practice Address - Zip Code:06379-1856
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:2011-11-25
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT89M057592RI01OtherANTHEM BLUE CROSS
RI900-9676Medicaid
TX0007849607OtherAETNA
RI9676-8OtherBC/BS RI
RI1598724007OtherWPS TRICARE
MA1598724007OtherUNICARE
RI0000009676OtherFEP BLUE CROSS
RI0082-0000017OtherUNITEDHEALTHCARE
RI402559OtherBLUE CHIP OF RHODE ISLAND
MA1598724007OtherUNICARE