Healthcare Provider Details

I. General information

NPI: 1053344515
Provider Name (Legal Business Name): RHODE ISLAND LIMB CO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1559 ELMWOOD AVE
CRANSTON RI
02910-3845
US

IV. Provider business mailing address

1559 ELMWOOD AVE
CRANSTON RI
02910-3845
US

V. Phone/Fax

Practice location:
  • Phone: 401-941-6230
  • Fax: 401-941-6339
Mailing address:
  • Phone: 401-941-6230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number3
License Number StateRI

VIII. Authorized Official

Name: MR. JONATHAN R TEOLI
Title or Position: PRESIDENT
Credential: CPO
Phone: 401-941-6230