MEDICARE: SPECIAL COMPANY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	PENDING	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00382095	OTHER		MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	M77024	OTHER		BLUE CROSS OF MASSACHUSETTS

General Provider Information

NPI Number	:	1154386951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIAL COMPANY LLC

Provider Business Mailing Address
First Line	:	39 EDGERTON DR
Second Line	:
City	:	N FALMOUTH
State	:	MA
Zip	:	02556-2821
Country	:	US
Telephone Number	:	508-274-6901
Fax Number	:	508-540-3158

Provider Business Practice Location Address
First Line	:	39 EDGERTON DR
Second Line	:
City	:	N FALMOUTH
State	:	MA
Zip	:	02556-2821
Country	:	US
Telephone Number	:	508-274-6901
Fax Number	:	508-540-3158

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GARRY BRAKE
Credential	:	M.D.
Telephone Number	:	508-540-9771

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	05/20/2008

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Directions to “SPECIAL COMPANY LLC ” Practice Location

Language	Start Address	Practice Location

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