Provider Demographics
NPI:1053043059
Name:ADVANCED SURGICAL & PHYSICIAN ASSISTANT SERVICES INC
Entity Type:Organization
Organization Name:ADVANCED SURGICAL & PHYSICIAN ASSISTANT SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:P
Authorized Official - Last Name:GREYSLAK
Authorized Official - Suffix:
Authorized Official - Credentials:PAC
Authorized Official - Phone:407-451-0192
Mailing Address - Street 1:PO BOX 410185
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32941-0185
Mailing Address - Country:US
Mailing Address - Phone:407-451-0192
Mailing Address - Fax:321-600-4004
Practice Address - Street 1:461 MALLARD LN
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-4735
Practice Address - Country:US
Practice Address - Phone:407-451-0192
Practice Address - Fax:321-600-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty