Healthcare Provider Details

I. General information

NPI: 1760518112
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

3724 CENTER RD SUITE 103
BRUNSWICK OH
44212-4400
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 330-273-4443
  • Fax: 330-273-4443
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