Provider Demographics
NPI:1942336300
Name:SURGICAL ASSOCIATES OF MEDINA
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES OF MEDINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:BICA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-722-3083
Mailing Address - Street 1:970 E WASHINGTON ST
Mailing Address - Street 2:SUITE 6-C
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3332
Mailing Address - Country:US
Mailing Address - Phone:330-722-3083
Mailing Address - Fax:330-725-5043
Practice Address - Street 1:195 WADSWORTH RD
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9504
Practice Address - Country:US
Practice Address - Phone:330-334-1504
Practice Address - Fax:330-334-2798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0723168Medicaid
OH0723168Medicaid