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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