Provider Demographics
NPI:1528479664
Name:HHC SOUTHINGTON SURGERY CENTER, LLC
Entity type:Organization
Organization Name:HHC SOUTHINGTON SURGERY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR BUSINESS SYSTEMS
Authorized Official - Prefix:
Authorized Official - First Name:LUCILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORMEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-667-9542
Mailing Address - Street 1:PO BOX 956
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001
Mailing Address - Country:US
Mailing Address - Phone:860-667-2066
Mailing Address - Fax:
Practice Address - Street 1:765 WEST JOHNSON AVENUE
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410
Practice Address - Country:US
Practice Address - Phone:860-378-8228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-12
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0341OtherSTATE OF CONNECTICUT LICENSE