Basic Information
| Provider Information | |||||||||
| NPI: | 1578989232 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INNOVATIVE SURGICAL CARE, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1350 BELMONT ST. | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7747762991 | ||||||||
| FaxNumber: | 7747762996 | ||||||||
| Practice Location | |||||||||
| Address1: | 1350 BELMONT ST. | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7747762991 | ||||||||
| FaxNumber: | 7747762996 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2014 | ||||||||
| LastUpdateDate: | 04/23/2021 | ||||||||
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| AuthorizedOfficialLastName: | ATANASSOV | ||||||||
| AuthorizedOfficialFirstName: | VALENTIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7747762991 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 04/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.