1346524980 NPI number — SURGI-CARE INC

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 1346524980 NPI number — SURGI-CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGI-CARE INC
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:
1346524980
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
71 1ST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALTHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02451-1105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-797-8744
Provider Business Mailing Address Fax Number:
800-338-6304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 PATRIOT PL
Provider Second Line Business Practice Location Address:
SUITE 220.09
Provider Business Practice Location Address City Name:
FOXBORO
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02035-1375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-718-4610
Provider Business Practice Location Address Fax Number:
508-718-4138
Provider Enumeration Date:
09/30/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DILIDDO
Authorized Official First Name:
DARCY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
781-290-1807

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1530691 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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