Healthcare Provider Details

I. General information

NPI: 1710068325
Provider Name (Legal Business Name): SERVICE MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 FRANKLIN ST
SPRINGVILLE NY
14141-1314
US

IV. Provider business mailing address

27 FRANKLIN ST
SPRINGVILLE NY
14141-1314
US

V. Phone/Fax

Practice location:
  • Phone: 716-592-7400
  • Fax: 716-592-7519
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number010878
License Number StateNY

VIII. Authorized Official

Name: DR. TIMOTHY SIEPEL
Title or Position: MEDICAL DOCTOR
Credential:
Phone: 716-592-7400