Provider Demographics
NPI:1629208863
Name:SURGICAL IMPLANT GROUP LLC
Entity Type:Organization
Organization Name:SURGICAL IMPLANT GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-832-0104
Mailing Address - Street 1:PO BOX 781838
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67278-1838
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2021 N AMIDON AVE
Practice Address - Street 2:SUITE 13
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-2100
Practice Address - Country:US
Practice Address - Phone:316-832-0104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies