Provider Demographics
NPI:1326239096
Name:WINDHAM ORTHOPAEDICS PROF CORP
Entity Type:Organization
Organization Name:WINDHAM ORTHOPAEDICS PROF CORP
Other - Org Name:ENFIELD ORTHOPAEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:MONTANO
Authorized Official - Last Name:PAPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-749-9325
Mailing Address - Street 1:111 HAZARD AVE
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4590
Mailing Address - Country:US
Mailing Address - Phone:860-749-8361
Mailing Address - Fax:860-749-2004
Practice Address - Street 1:111 HAZARD AVE
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4590
Practice Address - Country:US
Practice Address - Phone:860-749-8361
Practice Address - Fax:860-749-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004054722Medicaid
CT0442610002Medicare NSC
CT004054722Medicaid
CTC00613Medicare PIN