Provider Demographics
NPI:1780748806
Name:NORTH SMITHFIELD PODIATRY INC
Entity type:Organization
Organization Name:NORTH SMITHFIELD PODIATRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:401-769-5611
Mailing Address - Street 1:249 EDDIE DOWLING HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896
Mailing Address - Country:US
Mailing Address - Phone:401-769-5611
Mailing Address - Fax:401-769-6238
Practice Address - Street 1:249 EDDIE DOWLING HIGHWAY
Practice Address - Street 2:
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896
Practice Address - Country:US
Practice Address - Phone:401-769-5611
Practice Address - Fax:401-769-6238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDPM213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9007057Medicaid
2700284OtherUHC
480021635OtherRAILROAD MED
000262OtherTUFTS
0005952117OtherAETNA
33235OtherHARVARD
004962OtherBLUE CHIP
1506OtherNEIGHBORHOOD
000917250002OtherAARP MED
480021635OtherRAILROAD MED
T91550Medicare UPIN
RI9007057Medicaid
1506OtherNEIGHBORHOOD