1285746263 NPI number — ORTHOPEDICS SURGICAL CENTER OF THE NORTH SHORE LLC

Table of content: (NPI 1285746263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285746263 NPI number — ORTHOPEDICS SURGICAL CENTER OF THE NORTH SHORE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDICS SURGICAL CENTER OF THE NORTH SHORE LLC
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:
1285746263
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ONE ORTHOPEDICS DRIVE
Provider Second Line Business Mailing Address:
MAIN LEVEL
Provider Business Mailing Address City Name:
PEABODY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-818-6517
Provider Business Mailing Address Fax Number:
978-818-6357

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE ORTHOPEDICS DRIVE
Provider Second Line Business Practice Location Address:
MAIN LEVEL
Provider Business Practice Location Address City Name:
PEABODY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-818-6517
Provider Business Practice Location Address Fax Number:
978-818-6357
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LANDMAN
Authorized Official First Name:
JARETT
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
978-818-6405

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 586025 . This is a "TVFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 904471 . This is a "HPHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110069843B , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7406781 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9738410 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00298189 . This is a "RAIL ROAD MR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 91825 . This is a "FALLON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2243094 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3735704 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: M88033 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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