Provider Demographics
NPI:1750307336
Name:CHELSEA SURGICAL CARE LLC
Entity Type:Organization
Organization Name:CHELSEA SURGICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WESOLEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-886-0660
Mailing Address - Street 1:330 WASHINGTON ST
Mailing Address - Street 2:SUITE 420
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2700
Mailing Address - Country:US
Mailing Address - Phone:860-886-0660
Mailing Address - Fax:860-886-9305
Practice Address - Street 1:330 WASHINGTON ST
Practice Address - Street 2:SUITE 420
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2700
Practice Address - Country:US
Practice Address - Phone:860-886-0660
Practice Address - Fax:860-886-9305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT23658208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT50CHELSEACT01OtherBCBS
CTCI9443OtherMEDICARE RAILROAD
CT004182680Medicaid
CT004182680Medicaid