Provider Demographics
NPI:1891447173
Name:NORTH SHORE CENTER FOR ORTHOPEDIC SURGERY & SPORTS MEDICINE LLC
Entity Type:Organization
Organization Name:NORTH SHORE CENTER FOR ORTHOPEDIC SURGERY & SPORTS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:978-774-3400
Mailing Address - Street 1:4 STATE RD
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-2567
Mailing Address - Country:US
Mailing Address - Phone:978-774-3400
Mailing Address - Fax:978-774-5883
Practice Address - Street 1:4 STATE RD
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2567
Practice Address - Country:US
Practice Address - Phone:978-774-3400
Practice Address - Fax:978-774-5883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty