Provider Demographics
NPI:1285746263
Name:ORTHOPEDICS SURGICAL CENTER OF THE NORTH SHORE LLC
Entity type:Organization
Organization Name:ORTHOPEDICS SURGICAL CENTER OF THE NORTH SHORE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JARETT
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:LANDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:978-818-6405
Mailing Address - Street 1:ONE ORTHOPEDICS DRIVE
Mailing Address - Street 2:MAIN LEVEL
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960
Mailing Address - Country:US
Mailing Address - Phone:978-818-6517
Mailing Address - Fax:978-818-6357
Practice Address - Street 1:ONE ORTHOPEDICS DRIVE
Practice Address - Street 2:MAIN LEVEL
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960
Practice Address - Country:US
Practice Address - Phone:978-818-6517
Practice Address - Fax:978-818-6357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
586025OtherTVFTS
904471OtherHPHC
MA110069843BMedicaid
7406781OtherCIGNA
MA9738410Medicaid
P00298189OtherRAIL ROAD MR
91825OtherFALLON
2243094OtherFIRST HEALTH
3735704OtherAETNA
M88033OtherBCBS
MA110069843BMedicaid