Provider Demographics
NPI:1487610390
Name:SURGERY CENTER OF FAIRFIELD COUNTY LLC
Entity type:Organization
Organization Name:SURGERY CENTER OF FAIRFIELD COUNTY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:KYCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-993-0315
Mailing Address - Street 1:112 QUARRY RD FL 3
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4848
Mailing Address - Country:US
Mailing Address - Phone:203-374-1515
Mailing Address - Fax:
Practice Address - Street 1:112 QUARRY RD FL 3
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4848
Practice Address - Country:US
Practice Address - Phone:203-374-1515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0283261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
490000552Medicare PIN
CT07C0001003Medicare PIN