Healthcare Provider Details

I. General information

NPI: 1730045592
Provider Name (Legal Business Name): COMPREHENSIVE ORTHOPEDICS & MUSCULOSKELETAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2025
Last Update Date: 12/24/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N. MAIN STREET
SOUTHINGTON CT
06489
US

IV. Provider business mailing address

863 N MAIN STREET EXT STE 200
WALLINGFORD CT
06492-2434
US

V. Phone/Fax

Practice location:
  • Phone: 203-265-3280
  • Fax: 203-741-6569
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHY OLIVEIRA-GAGNON
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 401-573-4317