Provider Demographics
NPI:1205604295
Name:SUITE LIFE MEDICAL PC
Entity type:Organization
Organization Name:SUITE LIFE MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CXO
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMBRESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-567-5666
Mailing Address - Street 1:215 PLEASANT ST STE 5
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-3018
Mailing Address - Country:US
Mailing Address - Phone:508-567-5666
Mailing Address - Fax:508-567-5614
Practice Address - Street 1:215 PLEASANT ST STE 5
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-3018
Practice Address - Country:US
Practice Address - Phone:508-567-5666
Practice Address - Fax:508-567-5614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty