Healthcare Provider Details

I. General information

NPI: 1851668529
Provider Name (Legal Business Name): SOUTH COUNTY ARTIFICIAL LIMB CO., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2011
Last Update Date: 11/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 MENDON RD
WOONSOCKET RI
02895-2410
US

IV. Provider business mailing address

PO BOX 176
WEST KINGSTON RI
02892-0176
US

V. Phone/Fax

Practice location:
  • Phone: 401-769-1314
  • Fax: 401-789-3190
Mailing address:
  • Phone: 401-783-0063
  • Fax: 401-789-3190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateRI

VIII. Authorized Official

Name: LOIS A. JAMES
Title or Position: CORPORATE SECRETARY
Credential:
Phone: 401-783-0063