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General NPI Number Information
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NPI Number | 1154386951
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Entity Type | Organization
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Legal Business Name | SPECIAL COMPANY LLC
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 39 EDGERTON DR
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City | N FALMOUTH
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State | MA
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Zip | 02556-2821
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Country | US
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Telephone | 508-274-6901
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Fax | 508-540-3158
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Provider Business Mailing Address
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Address Line | 39 EDGERTON DR
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City | N FALMOUTH
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State | MA
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Zip | 02556-2821
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Country | US
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Telephone | 508-274-6901
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Fax | 508-540-3158
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARRY BRAKE
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Credential | M.D.
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Telephone | 508-540-9771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | PENDING
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License Number State | MA
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