Organization
SURGICAL CENTER OF CONNECTICUT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES A WALLACE (ADMINISTRATOR)
(203) 371-2986
Entity
Organization
Contact information
Practice address
4920 MAIN ST, BRIDGEPORT, CT 06606-1300
(203) 371-2986
(203) 371-2987
Mailing address
4920 MAIN ST, BRIDGEPORT, CT 06606-1300
(203) 371-2986
(203) 371-2987
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004248862
—
CT
Enumeration date
09/14/2006
Last updated
07/28/2015
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