Healthcare Provider Details

I. General information

NPI: 1821770025
Provider Name (Legal Business Name): COMPREHENSIVE ORTHOPEDICS & MUSCULOSKELETAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 MAIN ST STE 201
SOUTHINGTON CT
06489-2500
US

IV. Provider business mailing address

98 MAIN ST STE 201
SOUTHINGTON CT
06489-2500
US

V. Phone/Fax

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

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