Provider Demographics
NPI:1790168250
Name:SICARD SURGICAL SOLUTIONS
Entity Type:Organization
Organization Name:SICARD SURGICAL SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CSA
Authorized Official - Prefix:
Authorized Official - First Name:MITCHEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:SICARD
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:240-543-5182
Mailing Address - Street 1:2904 WHITE OAK ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-4641
Mailing Address - Country:US
Mailing Address - Phone:240-543-5182
Mailing Address - Fax:
Practice Address - Street 1:5257 BUCKEYSTOWN PIKE
Practice Address - Street 2:#244
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-7535
Practice Address - Country:US
Practice Address - Phone:240-543-5182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty