MEDICARE: SICARD SURGICAL SOLUTIONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant
2	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1790168250
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SICARD SURGICAL SOLUTIONS

Provider Business Mailing Address
First Line	:	2904 WHITE OAK ST
Second Line	:
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80129-4641
Country	:	US
Telephone Number	:	240-543-5182
Fax Number	:

Provider Business Practice Location Address
First Line	:	5257 BUCKEYSTOWN PIKE
Second Line	:	#244
City	:	FREDERICK
State	:	MD
Zip	:	21704-7535
Country	:	US
Telephone Number	:	240-543-5182
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CSA
Name	:	MITCHEL E SICARD
Credential	:	CSA
Telephone Number	:	240-543-5182

Provider Enumeration Date	:	07/02/2015
Last Update Date	:	09/04/2015

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Directions to “SICARD SURGICAL SOLUTIONS ” Practice Location

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