Organization
CONNECTICUT SURGICAL GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS C MCKELL (CHIEF ADMINISTRATIVE OFFICER)
(860) 524-4326
Entity
Organization
Contact information
Practice address
98 MAIN ST, SUITE 303, SOUTHINGTON, CT 06489-2500
(203) 238-1241
(860) 686-0791
Mailing address
17 TALCOTT NOTCH RD, FARMINGTON, CT 06032-1818
(860) 524-2626
(860) 677-5029
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004139350
—
CT
01
—
50CONNSURCT01
ANTHEM BCBS
CT
Enumeration date
11/28/2005
Last updated
10/21/2010
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