=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548509748
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SURGITECH, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2013
-----------------------------------------------------
Last Update Date | 02/07/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2772 GATEWAY RD
-----------------------------------------------------
City | CARLSBAD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92009-1746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-477-8191
-----------------------------------------------------
Fax | 760-758-9587
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2772 GATEWAY RD
-----------------------------------------------------
City | CARLSBAD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92009-1746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-477-8191
-----------------------------------------------------
Fax | 760-758-9587
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REGULATORY
-----------------------------------------------------
Name | MR. CHRISTOPHER A CROWELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 760-477-8191
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BC3200X
-----------------------------------------------------
Taxonomy Name | Customized Equipment (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------