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General NPI Number Information
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NPI Number | 1669577227
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Entity Type | Organization
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Legal Business Name | ANDOVER SURGERY CENTER, LP
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 138 HAVERHILL ST
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City | ANDOVER
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State | MA
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Zip | 01810-1509
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Country | US
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Telephone | 978-475-2880
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Fax | 978-475-7999
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Provider Business Mailing Address
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Address Line | 138 HAVERHILL ST
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City | ANDOVER
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State | MA
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Zip | 01810-1509
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Country | US
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Telephone | 978-475-2880
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Fax | 978-475-7999
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Authorized Official
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Title or Position | CEO
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Name | JORGEN MADSEN
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Credential |
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Telephone | 978-475-2880
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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 | 4278
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License Number State | MA
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