Provider Demographics
NPI:1669701157
Name:GLASTONBURY SURGERY CENTER, LLC
Entity type:Organization
Organization Name:GLASTONBURY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:PARENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-633-0003
Mailing Address - Street 1:195 EASTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1208
Mailing Address - Country:US
Mailing Address - Phone:860-633-0003
Mailing Address - Fax:860-633-2764
Practice Address - Street 1:195 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1208
Practice Address - Country:US
Practice Address - Phone:860-633-0003
Practice Address - Fax:860-633-2764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical