Provider Demographics
NPI:1871373035
Name:SICI MOHS CENTER PC
Entity type:Organization
Organization Name:SICI MOHS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CABELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-590-0295
Mailing Address - Street 1:6 BROOKHILL SQ S
Mailing Address - Street 2:
Mailing Address - City:SUGARLOAF
Mailing Address - State:PA
Mailing Address - Zip Code:18249-1010
Mailing Address - Country:US
Mailing Address - Phone:570-991-8292
Mailing Address - Fax:
Practice Address - Street 1:6 BROOKHILL SQ S
Practice Address - Street 2:
Practice Address - City:SUGARLOAF
Practice Address - State:PA
Practice Address - Zip Code:18249-1010
Practice Address - Country:US
Practice Address - Phone:704-590-0295
Practice Address - Fax:570-454-5757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-04
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty