Healthcare Provider Details

I. General information

NPI: 1710961800
Provider Name (Legal Business Name): NORTH COUNTRY ORTHOPAEDIC AMBULATORY SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1571 WASHINGTON ST SUITE 202
WATERTOWN NY
13601-9304
US

IV. Provider business mailing address

1571 WASHINGTON ST SUITE 202
WATERTOWN NY
13601-9304
US

V. Phone/Fax

Practice location:
  • Phone: 315-836-2200
  • Fax: 315-836-2201
Mailing address:
  • Phone: 315-836-2200
  • Fax: 315-836-2201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number2201205R
License Number StateNY

VIII. Authorized Official

Name: CAROL A HUGHES
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 315-836-2167