Healthcare Provider Details

I. General information

NPI: 1669577227
Provider Name (Legal Business Name): ANDOVER SURGERY CENTER, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 HAVERHILL ST
ANDOVER MA
01810-1509
US

IV. Provider business mailing address

138 HAVERHILL ST
ANDOVER MA
01810-1509
US

V. Phone/Fax

Practice location:
  • Phone: 978-475-2880
  • Fax: 978-475-7999
Mailing address:
  • Phone: 978-475-2880
  • Fax: 978-475-7999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number4278
License Number StateMA

VIII. Authorized Official

Name: JORGEN MADSEN
Title or Position: CEO
Credential:
Phone: 978-475-2880