Provider Demographics
NPI:1356510689
Name:GEORGE SICH III, DPM, LLC
Entity Type:Organization
Organization Name:GEORGE SICH III, DPM, LLC
Other - Org Name:PODIATRIC SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SICH
Authorized Official - Suffix:III
Authorized Official - Credentials:DPM
Authorized Official - Phone:803-648-6988
Mailing Address - Street 1:PO BOX 5725
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29804-5725
Mailing Address - Country:US
Mailing Address - Phone:803-648-6988
Mailing Address - Fax:803-648-6984
Practice Address - Street 1:901 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-7309
Practice Address - Country:US
Practice Address - Phone:803-648-6988
Practice Address - Fax:803-648-6984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC569213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5160450001Medicare NSC