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Organization
EPIC SURGICAL SOLUTION COMPANY
Active
Organization
EPIC SURGICAL SOLUTION COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WALLACE LARAY VINSON RSA (REGISTERED SURGICAL ASSISTANT)
(931) 215-1574
Entity
Organization
Contact information
Practice address
5885 FOREST VIEW RD, LISLE, IL 60532-2900
(931) 215-1574
(866) 535-5342
Mailing address
P.O. BOX 1416, BOLINGBROOK, IL 60440
(931) 215-1574
(866) 535-5342
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
238000042
IL
171W00000X
Contractor
Primary
238000232
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1235360959
NPI
IL
01
—
1881775880
NPI
IL
Enumeration date
06/03/2010
Last updated
06/03/2010
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