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General NPI Number Information
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NPI Number | 1821318643
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Entity Type | Organization
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Legal Business Name | EPIC SURGICAL SOLUTION COMPANY
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Dates
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Enumeration Date | 06/03/2010
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Last Update Date | 06/03/2010
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Provider Practice Location Address
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Address Line | 5885 FOREST VIEW RD
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City | LISLE
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State | IL
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Zip | 60532-2900
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Country | US
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Telephone | 931-215-1574
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Fax | 866-535-5342
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Provider Business Mailing Address
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Address Line | P.O. BOX 1416
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City | BOLINGBROOK
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State | IL
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Zip | 60440
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Country | US
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Telephone | 931-215-1574
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Fax | 866-535-5342
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Authorized Official
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Title or Position | REGISTERED SURGICAL ASSISTANT
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Name | MR. WALLACE LARAY VINSON
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Credential | RSA
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Telephone | 931-215-1574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 238000042
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 238000232
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License Number State | IL
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