Provider Demographics
NPI:1669577227
Name:ANDOVER SURGERY CENTER, LP
Entity type:Organization
Organization Name:ANDOVER SURGERY CENTER, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JORGEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MADSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-475-2880
Mailing Address - Street 1:138 HAVERHILL ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-1509
Mailing Address - Country:US
Mailing Address - Phone:978-475-2880
Mailing Address - Fax:978-475-7999
Practice Address - Street 1:138 HAVERHILL ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-1509
Practice Address - Country:US
Practice Address - Phone:978-475-2880
Practice Address - Fax:978-475-7999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4278261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1214110Medicaid
MA221006Medicare ID - Type Unspecified