Healthcare Provider Details

I. General information

NPI: 1962416800
Provider Name (Legal Business Name): R.P. SOUTTER ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 06/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 N MAIN ST
SOUTHINGTON CT
06489-2051
US

IV. Provider business mailing address

461 N MAIN ST
SOUTHINGTON CT
06489-2051
US

V. Phone/Fax

Practice location:
  • Phone: 860-621-9166
  • Fax: 860-621-9167
Mailing address:
  • Phone: 860-621-9166
  • Fax: 860-621-9167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number456560
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number456560
License Number StateCT

VIII. Authorized Official

Name: MR. ROBERT P. SOUTTER
Title or Position: PRESIDENT
Credential: CERT ORTHOTIC FITTER
Phone: 860-621-9166