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Organization

ORTHOPEDIC CARE SURGERY CENTER, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SIMON CORNELISSEN M.D. (CHIEF ADMINISTRATOR)
(781) 344-3535
Entity
Organization

Contact information

Practice address
15 ROCHE BROS. WAY, EASTON, MA 02356-1000
(781) 344-3535
(781) 341-2404
Mailing address
PO BOX 30, STOUGHTON, MA 02072-0030
(781) 344-3535
(781) 341-2404

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0770688
COMMONWEALTH INDEMNITY
MA
05
1855271
MA
01
650926
TUFTS HEALTH PLAN
MA
01
M88045
BLUE CROSS BLUE SHIELD
MA
Enumeration date
03/20/2007
Last updated
08/28/2008
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