Healthcare Provider Details

I. General information

NPI: 1497870505
Provider Name (Legal Business Name): ORTHOPEDIC CARE SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 ROCHE BROS. WAY
EASTON MA
02356-1000
US

IV. Provider business mailing address

PO BOX 30
STOUGHTON MA
02072-0030
US

V. Phone/Fax

Practice location:
  • Phone: 781-344-3535
  • Fax: 781-341-2404
Mailing address:
  • Phone: 781-344-3535
  • Fax: 781-341-2404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SIMON CORNELISSEN
Title or Position: CHIEF ADMINISTRATOR
Credential: M.D.
Phone: 781-344-3535