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General NPI Number Information
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NPI Number | 1235168337
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Entity Type | Organization
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Legal Business Name | SURGICAL SPECIALISTS A MEDICAL CORPORATION
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 05/21/2021
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Provider Practice Location Address
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Address Line | 316 S STRATFORD AVE STE C
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City | SANTA MARIA
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State | CA
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Zip | 93454-5908
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Country | US
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Telephone | 805-348-3700
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Fax | 805-348-3730
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Provider Business Mailing Address
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Address Line | PO BOX 1206
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City | GOLETA
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State | CA
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Zip | 93116-1206
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Country | US
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Telephone | 805-348-3700
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Fax | 805-348-3730
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS BOSSHARDT
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Credential | MD
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Telephone | 805-348-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A64528
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License Number State | CA
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