1811976103 NPI number — SURGICAL ASSOCIATES OF LITCHFIELD COUNTY, LLC

Table of content: (NPI 1811976103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811976103 NPI number — SURGICAL ASSOCIATES OF LITCHFIELD COUNTY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL ASSOCIATES OF LITCHFIELD COUNTY, 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:
1811976103
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
538 LITCHFIELD ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
TORRINGTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06790-6669
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-489-7017
Provider Business Mailing Address Fax Number:
860-489-8943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
538 LITCHFIELD ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
TORRINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06790-6669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-489-7017
Provider Business Practice Location Address Fax Number:
860-489-8943
Provider Enumeration Date:
01/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PRETE
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
SINGLE MEMBER
Authorized Official Telephone Number:
860-496-6434

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)

  • Identifier: C03110 . This identifiers is of the category "MEDICARE ID-TYPE UNSPECIFIED".
  • Identifier: 3487189 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".