Provider Demographics
NPI:1194943845
Name:LINCOLN PSYCHIATRIC SERVICES, INC.
Entity type:Organization
Organization Name:LINCOLN PSYCHIATRIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:D
Authorized Official - Last Name:FITZHUGH
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:401-334-1830
Mailing Address - Street 1:652 GEORGE WASHINGTON HWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-4267
Mailing Address - Country:US
Mailing Address - Phone:401-334-1830
Mailing Address - Fax:401-334-1833
Practice Address - Street 1:652 GEORGE WASHINGTON HWY
Practice Address - Street 2:SUITE 400
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-4267
Practice Address - Country:US
Practice Address - Phone:401-334-1830
Practice Address - Fax:401-334-1833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD093132084A0401X
MA787552084A0401X
RIPPNS00043364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI269081074Medicare PIN