Organization
CIVISTA CLINICAL SERVICES, LLC
Active
Parent organization
CIVISTA CLINICAL SERVICES, LLC
Other names
La Plata Surgical Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
CIVISTA CLINICAL SERVICES, LLC
Authorized official
STEPHANIE SIMM (PHYSICIAN RELATIONS SPECIALIST)
(301) 609-4539
Entity
Organization
Contact information
Practice address
500 CHARLES ST, LA PLATA, MD 20646-5931
(301) 609-4539
Mailing address
75 REMITTANCE DR DEPT 6554, CHICAGO, IL 60675-6554
(301) 609-4539
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
—
—
208600000X
Surgery Physician
Primary
—
—
2086S0129X
Vascular Surgery Physician
—
—
Other
Enumeration date
05/29/2012
Last updated
06/12/2014
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