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General NPI Number Information
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NPI Number | 1710961800
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Entity Type | Organization
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Legal Business Name | NORTH COUNTRY ORTHOPAEDIC AMBULATORY SURGERY CENTER LLC
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Dates
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Enumeration Date | 12/01/2005
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 1571 WASHINGTON ST SUITE 202
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City | WATERTOWN
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State | NY
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Zip | 13601-9304
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Country | US
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Telephone | 315-836-2200
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Fax | 315-836-2201
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Provider Business Mailing Address
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Address Line | 1571 WASHINGTON ST SUITE 202
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City | WATERTOWN
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State | NY
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Zip | 13601-9304
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Country | US
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Telephone | 315-836-2200
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Fax | 315-836-2201
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Authorized Official
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Title or Position | EXECUTIVE ASSISTANT
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Name | CAROL A HUGHES
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Credential |
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Telephone | 315-836-2167
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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 | 2201205R
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License Number State | NY
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