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General NPI Number Information
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NPI Number | 1023440286
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Entity Type | Organization
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Legal Business Name | SURGICAL CARE WEST, PLLC
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Dates
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Enumeration Date | 07/30/2013
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Last Update Date | 07/30/2013
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Provider Practice Location Address
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Address Line | 5700 W GENESEE ST STE. 201N
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City | CAMILLUS
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State | NY
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Zip | 13031-3200
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Country | US
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Telephone | 315-488-5588
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Fax | 315-488-5892
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Provider Business Mailing Address
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Address Line | 5700 W GENESEE ST STE. 201N
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City | CAMILLUS
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State | NY
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Zip | 13031-3200
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Country | US
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Telephone | 315-488-5588
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Fax | 315-488-5892
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MARIANNE DILLON
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Credential | CPC
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Telephone | 315-492-5777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 144705
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License Number State | NY
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