1184064610 NPI number — ORTHOPEDIC SURGICAL PARTNERS, PC

Table of content: (NPI 1184064610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184064610 NPI number — ORTHOPEDIC SURGICAL PARTNERS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDIC SURGICAL PARTNERS, 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:
HARTFORD ORTHOPEDIC SURGEONS, PC
Provider Other Organization Name Type Code:
4
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:
1184064610
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1111 CROMWELL AVE STE 403
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKY HILL
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06067-3454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-525-4469
Provider Business Mailing Address Fax Number:
860-999-9305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
277 MIDDLE TPKE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06040-3834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-432-4640
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/28/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MARA
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
860-525-4469

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: C01240 . This is a "MEDICARE PTAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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