Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Ambulatory Surgical |
261QA1903X | 49 | Ambulatory Surgical Center |
| NPI # | 1306142245 |
| LBN Legal business name | 51 JOHN STREET MEDICAL PC |
| Authorized official | TERESA FULLER - (OFFICE MANAGER) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 02/09/2011 |
| Last updated | 07/22/2020 - About 6 years ago |
| Identifiers | n/a |
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51 JOHN STREET MEDICAL PC
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