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General NPI Number Information
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NPI Number | 1871641571
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Entity Type | Organization
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Legal Business Name | MID COUNTY SURGICAL MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 603 CAPITOLA AVE
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City | CAPITOLA
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State | CA
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Zip | 95010-2751
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Country | US
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Telephone | 831-476-5403
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Fax | 831-476-4107
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Provider Business Mailing Address
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Address Line | 603 CAPITOLA AVE
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City | CAPITOLA
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State | CA
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Zip | 95010-2751
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Country | US
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Telephone | 831-476-5403
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Fax | 831-476-4107
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN CAMARA ANANE-SEFAH
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Credential | M.D.
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Telephone | 831-476-5403
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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 | G23854
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License Number State | CA
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