MEDICARE: SURGICAL IMPLANT GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1629208863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL IMPLANT GROUP LLC

Provider Business Mailing Address
First Line	:	PO BOX 781838
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67278-1838
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2021 N AMIDON AVE
Second Line	:	SUITE 13
City	:	WICHITA
State	:	KS
Zip	:	67203-2100
Country	:	US
Telephone Number	:	316-832-0104
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ALAN BURKE
Credential	:
Telephone Number	:	316-832-0104

Provider Enumeration Date	:	07/22/2009
Last Update Date	:	07/22/2009

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Directions to “SURGICAL IMPLANT GROUP LLC ” Practice Location

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