Provider Demographics
NPI:1861605354
Name:EAST SIDE ORTHOPAEDICS, INC
Entity type:Organization
Organization Name:EAST SIDE ORTHOPAEDICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:BLISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-831-4110
Mailing Address - Street 1:124 WATERMAN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-2052
Mailing Address - Country:US
Mailing Address - Phone:401-831-4110
Mailing Address - Fax:401-831-2305
Practice Address - Street 1:124 WATERMAN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2052
Practice Address - Country:US
Practice Address - Phone:401-831-4110
Practice Address - Fax:401-831-2305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI4203207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIES00776Medicaid
RI7002079Medicaid
RIES00776Medicaid