Provider Demographics
NPI:1780863456
Name:MILL CITY SURGICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:MILL CITY SURGICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-420-1050
Mailing Address - Street 1:62 BROWN ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6778
Mailing Address - Country:US
Mailing Address - Phone:978-420-1050
Mailing Address - Fax:978-420-1063
Practice Address - Street 1:62 BROWN ST
Practice Address - Street 2:SUITE 405
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6778
Practice Address - Country:US
Practice Address - Phone:978-420-1050
Practice Address - Fax:978-420-1063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208279208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0119121Medicaid
A31869Medicare PIN