Connecticut Surgical Group, Pc
Legal Business Name
Connecticut Surgical Group, Pc
NPI Number
1558344895
NPI Type
Organization
Enumeration Date
11/21/2005
Specialties
(Taxonomies)Name
Code
208C00000X
213ES0103X
208200000X
2086S0122X
213E00000X
208600000X
2086S0105X
2086X0206X
208800000X
Primary Taxonomy
No
No
No
No
No
No
No
No
No
Contact
Information
Purpose
Mailing
Location
Address
17 TALCOTT NOTCH RD
65 MEMORIAL RD
City
Farmington
West Hartford
State
CT
CT
Postal Code
06032-1818
06107-2434
Country
US
US
Telephone Number
(860) 547-0616
(860) 547-0616
Authorized Official
Name
Douglas Mckell
Title or Position
CHIEF ADMINISTRATIVE OFFICER
Telephone Number
(860) 524-4326
Identifiers
Identifier
004139350
9781188
004169711
004201034
50CONNSURCT01
01926310
Identifier State
CT
MA
CT
CT
CT
NY
Identifier Issuer
Unknown
Unknown
Unknown
Unknown
ANTHEM BCBS
Unknown
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 08/11/2010