Provider Demographics
NPI:1720227945
Name:WESTERN CONNECTICUT ORTHOPEDIC SURGICAL CENTER LLC
Entity Type:Organization
Organization Name:WESTERN CONNECTICUT ORTHOPEDIC SURGICAL CENTER LLC
Other - Org Name:THE HAND CENTER OF WESTERN CONNECTICUT LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SEARLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-791-9557
Mailing Address - Street 1:226 WHITE ST
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6814
Mailing Address - Country:US
Mailing Address - Phone:203-791-9557
Mailing Address - Fax:203-791-9667
Practice Address - Street 1:226 WHITE ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6814
Practice Address - Country:US
Practice Address - Phone:203-791-9557
Practice Address - Fax:203-791-9667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0304261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT490000217OtherPHYSICIAN OR SUPPLIER IDENTIFICATION CODE