MEDICARE: SURGEON'S CHOICE, 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	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1659966596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGEON'S CHOICE, LLC

Provider Business Mailing Address
First Line	:	1555 1ST ST
Second Line	:
City	:	COLUMBIA CITY
State	:	OR
Zip	:	97018-9505
Country	:	US
Telephone Number	:	503-702-6438
Fax Number	:

Provider Business Practice Location Address
First Line	:	1555 1ST ST
Second Line	:
City	:	COLUMBIA CITY
State	:	OR
Zip	:	97018-9505
Country	:	US
Telephone Number	:	503-702-6438
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	ZACHARY MEILING
Credential	:	CSFA
Telephone Number	:	503-702-6438

Provider Enumeration Date	:	03/03/2021
Last Update Date	:	01/06/2022

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