Organization
SPECIAL COMPANY LLC
Active
Other names
Bayside Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARRY BRAKE M.D. (PRESIDENT)
(508) 540-9771
Entity
Organization
Contact information
Practice address
39 EDGERTON DR, N FALMOUTH, MA 02556-2821
(508) 274-6901
(508) 540-3158
Mailing address
39 EDGERTON DR, N FALMOUTH, MA 02556-2821
(508) 274-6901
(508) 540-3158
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
PENDING
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1851179
—
MA
01
—
M77024
BLUE CROSS OF MASSACHUSETTS
—
01
—
P00382095
MEDICARE RAILROAD
—
Enumeration date
04/18/2006
Last updated
05/20/2008
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