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General NPI Number Information
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NPI Number | 1962416800
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Entity Type | Organization
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Legal Business Name | R.P. SOUTTER ENTERPRISES, INC.
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 06/02/2011
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Provider Practice Location Address
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Address Line | 461 N MAIN ST
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City | SOUTHINGTON
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State | CT
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Zip | 06489-2051
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Country | US
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Telephone | 860-621-9166
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Fax | 860-621-9167
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Provider Business Mailing Address
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Address Line | 461 N MAIN ST
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City | SOUTHINGTON
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State | CT
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Zip | 06489-2051
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Country | US
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Telephone | 860-621-9166
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Fax | 860-621-9167
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT P. SOUTTER
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Credential | CERT ORTHOTIC FITTER
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Telephone | 860-621-9166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 456560
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 456560
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License Number State | CT
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