Provider Demographics
NPI:1215946827
Name:SOUTH COUNTY INTERNAL MEDICINE, INC.
Entity type:Organization
Organization Name:SOUTH COUNTY INTERNAL MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUERRIERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-789-0283
Mailing Address - Street 1:481 KINGSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3626
Mailing Address - Country:US
Mailing Address - Phone:401-789-0283
Mailing Address - Fax:401-789-0314
Practice Address - Street 1:481 KINGSTOWN RD
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3626
Practice Address - Country:US
Practice Address - Phone:401-789-0283
Practice Address - Fax:401-789-0314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI=========OtherTAX ID