Healthcare Provider Details

I. General information

NPI: 1104800788
Provider Name (Legal Business Name): BRISTOL ORTHOPAEDICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 CLARK AVE
BRISTOL CT
06010-4068
US

IV. Provider business mailing address

641 CLARK AVE
BRISTOL CT
06010-4068
US

V. Phone/Fax

Practice location:
  • Phone: 860-582-6603
  • Fax: 860-585-9245
Mailing address:
  • Phone: 860-582-6603
  • Fax: 860-585-9245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT W ORGAN
Title or Position: MD PARTNER
Credential: MD
Phone: 860-582-6603