Provider Demographics
NPI:1770532566
Name:ORTHOPEDIC ASSOCIATES OF WINDHAM COUNTY LLP
Entity type:Organization
Organization Name:ORTHOPEDIC ASSOCIATES OF WINDHAM COUNTY LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NATHANAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:TRYTHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-963-2133
Mailing Address - Street 1:35 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1939
Mailing Address - Country:US
Mailing Address - Phone:860-963-2133
Mailing Address - Fax:860-963-8955
Practice Address - Street 1:35 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1939
Practice Address - Country:US
Practice Address - Phone:860-963-2133
Practice Address - Fax:860-963-8955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC01454Medicare ID - Type Unspecified