Provider Demographics
NPI:1760540397
Name:SURGICAL ASSOCIATES OF NORWICH LLC
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES OF NORWICH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-889-3841
Mailing Address - Street 1:330 WASHINGTON ST
Mailing Address - Street 2:SUITE 520
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360
Mailing Address - Country:US
Mailing Address - Phone:860-889-3841
Mailing Address - Fax:860-887-3840
Practice Address - Street 1:330 WASHINGTON ST
Practice Address - Street 2:SUITE 520
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360
Practice Address - Country:US
Practice Address - Phone:860-889-3841
Practice Address - Fax:860-887-3840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT016369208600000X
CT030790208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010016369CT02OtherANTHEM BCBS
CT031272OtherHEALTH NET
CT2590570-003OtherCIGNA
CT1021476OtherAETNA
CT180867OtherPREFERRED ONE
CTC02296OtherMEDICARE GROUP NUMBER
CTNLS046OtherOXFORD
CT2590570-003OtherCIGNA