Provider Demographics
NPI:1467057372
Name:SOUTHWEST CONNECTICUT SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:SOUTHWEST CONNECTICUT SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR BUSINESS SYSTEMS
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORMEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-667-9542
Mailing Address - Street 1:PO BOX 1434
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-1434
Mailing Address - Country:US
Mailing Address - Phone:860-667-3542
Mailing Address - Fax:860-667-2066
Practice Address - Street 1:60 DANBURY RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-4406
Practice Address - Country:US
Practice Address - Phone:476-257-6500
Practice Address - Fax:475-257-6520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical