Provider Demographics
NPI:1760994354
Name:SILLECT ORTHOPEDIC GROUP
Entity Type:Organization
Organization Name:SILLECT ORTHOPEDIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TY
Authorized Official - Middle Name:
Authorized Official - Last Name:HECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-706-9444
Mailing Address - Street 1:2901 SILLECT AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-6371
Mailing Address - Country:US
Mailing Address - Phone:661-327-2101
Mailing Address - Fax:661-327-2554
Practice Address - Street 1:2901 SILLECT AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-6371
Practice Address - Country:US
Practice Address - Phone:661-327-2101
Practice Address - Fax:661-327-2554
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALIFORNIA INSTITUTE OF COSMETIC & RECONSTRUCTIVE SURGERY A MEDICAL CO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-03
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38702207X00000X
207X00000X
CAA636392086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty