Provider Demographics
NPI:1699795450
Name:FOOT CENTRAL USA
Entity type:Organization
Organization Name:FOOT CENTRAL USA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:VIGEANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-521-1700
Mailing Address - Street 1:1 RICHMOND SQ STE 147N
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5136
Mailing Address - Country:US
Mailing Address - Phone:401-521-1700
Mailing Address - Fax:
Practice Address - Street 1:1 RICHMOND SQ STE 147N
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5136
Practice Address - Country:US
Practice Address - Phone:401-521-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI412012OtherBLUE CHIP
RI227076OtherBCBS OF RI
MAZDY747OtherBCBS OF MASS
MAZDY747OtherBCBS OF MASS
RI5036940002Medicare ID - Type UnspecifiedMEDICARE