Constitution Surgery Center East LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

0272 Issued in CT

Legal business name

CONSTITUTION SURGERY CENTER EAST LLC

Practice address

174 Cross Rd
Waterford, CT 06385-1215

Phone

(860) 701-0140

Fax

(860) 701-0161

NPI assigned

Jul 16, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Kris Mineau

Title

Administrator

Phone

(860) 667-1815

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Listed as

Constitution Surgery Center East LLCCCN 07C0001030

Medicare certification status

ActiveFrom the Provider of Services file

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• The William W Backus Hospital

  • General Acute Care Hospital
  • Norwich, CT
  • NPI 1639135718

  Member Of

  NPD member

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431907200000",
    "number": "1588681373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 AVON MEADOW LN",
            "city": "AVON",
            "state": "CT",
            "postal_code": "060014703",
            "telephone_number": "860-667-1815",
            "fax_number": "860-838-6480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "174 CROSS RD",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "063851215",
            "telephone_number": "860-701-0140",
            "fax_number": "860-701-0161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONSTITUTION SURGERY CENTER EAST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2015-05-18",
        "status": "A",
        "authorized_official_last_name": "MINEAU",
        "authorized_official_first_name": "KRIS",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "860-667-1815",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CT",
            "license": "0272",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004219475",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• James J Connolly, PH.D
• Karen Coombs, LPC
• Claudia Cooper
• Edward William Coss Jr., M.D.
• Maryjane Couillard, RPH
• County Hearing and Balance, Inc.

• Ambulatory Surgical Clinic/Center in Waterford, CT
• Providers in Waterford, CT by specialty
• Ambulatory Surgical Clinic/Center in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.