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General NPI Number Information
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NPI Number | 1962501056
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Entity Type | Organization
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Legal Business Name | SYCAMORE MEDICAL ASSOCIATES, INC.
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 10/13/2009
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Provider Practice Location Address
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Address Line | 103 N PENNINGTON ST
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City | SYCAMORE
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State | OH
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Zip | 44882-9408
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Country | US
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Telephone | 419-927-6552
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Fax | 419-927-6500
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Provider Business Mailing Address
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Address Line | 103 N PENNINGTON ST
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City | SYCAMORE
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State | OH
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Zip | 44882-9408
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Country | US
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Telephone | 419-927-6552
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Fax | 419-927-6500
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Authorized Official
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Title or Position | PRESIDENT
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Name | N SCOTT CISAR
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Credential | M.D.
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Telephone | 419-927-6552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | OH
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