Provider Demographics
NPI:1972096923
Name:LMB MEDICAL LLC
Entity type:Organization
Organization Name:LMB MEDICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MGR
Authorized Official - Prefix:
Authorized Official - First Name:S
Authorized Official - Middle Name:
Authorized Official - Last Name:MALATESTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-910-2833
Mailing Address - Street 1:127 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5305
Mailing Address - Country:US
Mailing Address - Phone:401-475-3040
Mailing Address - Fax:
Practice Address - Street 1:127 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860
Practice Address - Country:US
Practice Address - Phone:401-475-3040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-13
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1104110030Medicaid
RI1679512354Medicaid
RI1265631972Medicaid