MEDICARE: FITCH SURGICAL ASSISTING 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	246ZC0007X	Surgical Assistant	SA00651	TX

General Provider Information

NPI Number	:	1982193132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FITCH SURGICAL ASSISTING GROUP, LLC

Provider Business Mailing Address
First Line	:	6163 JOHN CHAPMAN
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240
Country	:	US
Telephone Number	:	210-900-5337
Fax Number	:

Provider Business Practice Location Address
First Line	:	6163 JOHN CHAPMAN
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240
Country	:	US
Telephone Number	:	210-900-5337
Fax Number	:

Authorized Official
Title or Position	:	LSA
Name	:	CHIZELLE MARGARITA FITCH
Credential	:	LSA
Telephone Number	:	210-900-5337

Provider Enumeration Date	:	05/03/2018
Last Update Date	:	05/03/2018

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