Provider Demographics
NPI:1710961800
Name:NORTH COUNTRY ORTHOPAEDIC AMBULATORY SURGERY CENTER LLC
Entity Type:Organization
Organization Name:NORTH COUNTRY ORTHOPAEDIC AMBULATORY SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-836-2167
Mailing Address - Street 1:1571 WASHINGTON ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-9304
Mailing Address - Country:US
Mailing Address - Phone:315-836-2200
Mailing Address - Fax:315-836-2201
Practice Address - Street 1:1571 WASHINGTON ST
Practice Address - Street 2:SUITE 202
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-9304
Practice Address - Country:US
Practice Address - Phone:315-836-2200
Practice Address - Fax:315-836-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2201205R261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02385528Medicaid
NYDD5409Medicare PIN