Provider Demographics
NPI:1659695377
Name:SURGICAL DEVICEEXCHANGE
Entity Type:Organization
Organization Name:SURGICAL DEVICEEXCHANGE
Other - Org Name:SIERRA SURGICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENHALGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-759-7999
Mailing Address - Street 1:1850 S. OCEAN DR. #1910
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33009
Mailing Address - Country:US
Mailing Address - Phone:916-759-7999
Mailing Address - Fax:
Practice Address - Street 1:1850 S OCEAN DR APT 1910
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-7681
Practice Address - Country:US
Practice Address - Phone:916-759-7999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies