Provider Demographics
NPI:1962416800
Name:R.P. SOUTTER ENTERPRISES, INC.
Entity type:Organization
Organization Name:R.P. SOUTTER ENTERPRISES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:SOUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:CERT ORTHOTIC FITTER
Authorized Official - Phone:860-621-9166
Mailing Address - Street 1:461 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-2051
Mailing Address - Country:US
Mailing Address - Phone:860-621-9166
Mailing Address - Fax:860-621-9167
Practice Address - Street 1:461 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-2051
Practice Address - Country:US
Practice Address - Phone:860-621-9166
Practice Address - Fax:860-621-9167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT456560332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004068847Medicaid
CT0R4654OtherHEALTHNET
CT245161OtherWELLCARE
CT12DME0264CT01OtherANTHEM BLUE CROSS
CT245161OtherWELLCARE