Healthcare Provider Details

I. General information

NPI: 1861936155
Provider Name (Legal Business Name): SURGICAL FUSION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2016
Last Update Date: 09/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 N HIGH ST # 237
COLUMBUS OH
43215-2024
US

IV. Provider business mailing address

605 N HIGH ST # 237
COLUMBUS OH
43215-2024
US

V. Phone/Fax

Practice location:
  • Phone: 614-907-7294
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE SILVA
Title or Position: PAMS NPI ADMINISTRATOR
Credential:
Phone: 210-598-4287