Provider Demographics
NPI:1508041427
Name:ARTHROSCOPY SPORTS MEDICINE AND MINIMALLY INVASIVE ASSOCIATES PC
Entity Type:Organization
Organization Name:ARTHROSCOPY SPORTS MEDICINE AND MINIMALLY INVASIVE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MCGLOWAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:781-618-1944
Mailing Address - Street 1:49 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2878
Mailing Address - Country:US
Mailing Address - Phone:781-618-1944
Mailing Address - Fax:781-618-1947
Practice Address - Street 1:49 PEARL ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2878
Practice Address - Country:US
Practice Address - Phone:781-618-1944
Practice Address - Fax:781-618-1947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2023-11-28
Deactivation Date:2008-06-03
Deactivation Code:
Reactivation Date:2008-07-02
Provider Licenses
StateLicense IDTaxonomies
MA210655207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM19565OtherBCBS
MA110081851AMedicaid
MAM19565OtherBCBS