Provider Demographics
NPI:1821770025
Name:COMPREHENSIVE ORTHOPEDICS & MUSCULOSKELETAL CARE LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE ORTHOPEDICS & MUSCULOSKELETAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVEIRA-GAGNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-573-4317
Mailing Address - Street 1:98 MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-2500
Mailing Address - Country:US
Mailing Address - Phone:203-265-3280
Mailing Address - Fax:203-741-6569
Practice Address - Street 1:98 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-2500
Practice Address - Country:US
Practice Address - Phone:203-265-3280
Practice Address - Fax:203-741-6569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty