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General NPI Number Information
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NPI Number | 1790168250
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Entity Type | Organization
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Legal Business Name | SICARD SURGICAL SOLUTIONS
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Dates
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Enumeration Date | 07/02/2015
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Last Update Date | 09/04/2015
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Provider Practice Location Address
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Address Line | 5257 BUCKEYSTOWN PIKE #244
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City | FREDERICK
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State | MD
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Zip | 21704-7535
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Country | US
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Telephone | 240-543-5182
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Fax |
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Provider Business Mailing Address
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Address Line | 2904 WHITE OAK ST
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City | HIGHLANDS RANCH
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State | CO
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Zip | 80129-4641
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Country | US
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Telephone | 240-543-5182
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CSA
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Name | MITCHEL E SICARD
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Credential | CSA
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Telephone | 240-543-5182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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