MEDICARE: MATTHEW WILLIAM MCMICKEN CSFA

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	246ZC0007X	Surgical Assistant	0136000664	VA

General Provider Information

NPI Number	:	1649139031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW WILLIAM MCMICKEN CSFA

Provider Business Mailing Address
First Line	:	145 COUNTY ROAD 407
Second Line	:
City	:	CULLMAN
State	:	AL
Zip	:	35057-1247
Country	:	US
Telephone Number	:	205-260-7273
Fax Number	:

Provider Business Practice Location Address
First Line	:	13710 ST FRANCIS BLVD
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23114-3267
Country	:	US
Telephone Number	:	804-594-7300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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