Provider Demographics
NPI:1497870505
Name:ORTHOPEDIC CARE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:ORTHOPEDIC CARE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNELISSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-344-3535
Mailing Address - Street 1:PO BOX 30
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-0030
Mailing Address - Country:US
Mailing Address - Phone:781-344-3535
Mailing Address - Fax:781-341-2404
Practice Address - Street 1:15 ROCHE BROS. WAY
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1000
Practice Address - Country:US
Practice Address - Phone:781-344-3535
Practice Address - Fax:781-341-2404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA650926OtherTUFTS HEALTH PLAN
MAM88045OtherBLUE CROSS BLUE SHIELD
MA1855271Medicaid
MA0770688OtherCOMMONWEALTH INDEMNITY
MA650926OtherTUFTS HEALTH PLAN