Healthcare Provider Details

I. General information

NPI: 1427184886
Provider Name (Legal Business Name): SURGICAL ASSOCIATES OF MEDINA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 CENTER ST
ASHLAND OH
44805-4011
US

IV. Provider business mailing address

970 E WASHINGTON ST SUITE 6-C
MEDINA OH
44256-3332
US

V. Phone/Fax

Practice location:
  • Phone: 800-257-9917
  • Fax: 419-207-2629
Mailing address:
  • Phone: 330-722-3083
  • Fax: 330-725-5043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name: THOMAS DENNIS BICA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 330-722-3083