Provider Demographics
NPI:1033725197
Name:ADVANCED SURGICAL ASSOCIATES OF NORTHERN MINNESOTA PLLC
Entity Type:Organization
Organization Name:ADVANCED SURGICAL ASSOCIATES OF NORTHERN MINNESOTA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BOLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:218-461-2212
Mailing Address - Street 1:PO BOX 15042
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55815-0042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4325 9TH AVE W
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-3032
Practice Address - Country:US
Practice Address - Phone:218-461-2122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2021-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty