Organization
CONSTITUTION SURGERY CENTER EAST LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KRIS MINEAU (ADMINISTRATOR)
(860) 667-1815
Entity
Organization
Contact information
Practice address
174 CROSS RD, WATERFORD, CT 06385-1215
(860) 701-0140
(860) 701-0161
Mailing address
100 AVON MEADOW LN, AVON, CT 06001-4703
(860) 667-1815
(860) 838-6480
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0272
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004219475
—
CT
Enumeration date
07/16/2006
Last updated
05/18/2015
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