Provider Demographics
NPI:1275554222
Name:SHAWS COVE ORTHOPAEDICS, LLC
Entity Type:Organization
Organization Name:SHAWS COVE ORTHOPAEDICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:860-444-9022
Mailing Address - Street 1:6 SHAWS CV
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4969
Mailing Address - Country:US
Mailing Address - Phone:860-444-9022
Mailing Address - Fax:860-444-7768
Practice Address - Street 1:6 SHAWS CV
Practice Address - Street 2:SUITE 101
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4969
Practice Address - Country:US
Practice Address - Phone:860-444-9022
Practice Address - Fax:860-444-7768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000371207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1184692162OtherDMERC
CTC03028Medicare PIN
CT1184692162OtherDMERC
DB2419Medicare PIN