# CONSTITUTION SURGERY CENTER EAST LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588681373
- **Authorized official:** MR. KRIS MINEAU (ADMINISTRATOR)
- **Authorized official phone:** (860) 667-1815

## Contact information

- **Practice address:** 174 CROSS RD, WATERFORD, CT 06385-1215
- **Practice address phone:** (860) 701-0140
- **Practice address fax:** (860) 701-0161
- **Mailing address:** 100 AVON MEADOW LN, AVON, CT 06001-4703
- **Mailing address phone:** (860) 667-1815
- **Mailing address fax:** (860) 838-6480

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 0272 | CT | Yes |

## Other

- **Enumeration date:** 07/16/2006
- **Last updated:** 05/18/2015