Civista Clinical Services, LLC

NPI #1710247440 in La Plata, Maryland

Provider Information

NPI Number: 1710247440
Entity Type: Organization
Organization Name: Civista Clinical Services, LLC
Subpart: Yes (part of a larger organization)
Parent Organization: CIVISTA CLINICAL SERVICES, LLC
Primary Specialty: Surgery
Enumeration Date: May 29, 2012
Last Updated: Jun 12, 2014

Practice Location

Address: 500 CHARLES ST
City: La Plata
State: Maryland
ZIP Code: 20646-5931
Phone: (301) 609-4539

Authorized Official

Name: STEPHANIE SIMM
Title: PHYSICIAN RELATIONS SPECIALIST
Phone: (301) 609-4539

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Otolaryngology	207Y00000X
Surgery - Vascular Surgery — Vascular Surgery	2086S0129X
Surgery	208600000X	Primary

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