Healthcare Provider Details

I. General information

NPI: 1396668562
Provider Name (Legal Business Name): JM SURGICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 SEYMOUR ST
HARTFORD CT
06106-5503
US

IV. Provider business mailing address

PO BOX 307
FARMINGTON CT
06034-0307
US

V. Phone/Fax

Practice location:
  • Phone: 860-595-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA MILES
Title or Position: OWNER
Credential: PA-C
Phone: 860-690-6325