Healthcare Provider Details

I. General information

NPI: 1942568621
Provider Name (Legal Business Name): KIMBALLI P STARTZ HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 POST RD
WARWICK RI
02886
US

IV. Provider business mailing address

3520 POST RD
WARWICK RI
02886-7140
US

V. Phone/Fax

Practice location:
  • Phone: 401-921-0181
  • Fax: 401-921-5826
Mailing address:
  • Phone: 401-921-0181
  • Fax: 401-921-5826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number000322
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAD00124
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: