1578989232 NPI number — INNOVATIVE SURGICAL CARE, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578989232 NPI number — INNOVATIVE SURGICAL CARE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNOVATIVE SURGICAL CARE, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578989232
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1350 BELMONT ST.
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
BROCKTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
774-776-2991
Provider Business Mailing Address Fax Number:
774-776-2996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1350 BELMONT ST.
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
BROCKTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
774-776-2991
Provider Business Practice Location Address Fax Number:
774-776-2996
Provider Enumeration Date:
03/05/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ATANASSOV
Authorized Official First Name:
VALENTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
774-776-2991

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com