Provider Demographics
NPI:1053323451
Name:ALLIED SURGICAL ASSISTANT PARTNERS PLLC
Entity Type:Organization
Organization Name:ALLIED SURGICAL ASSISTANT PARTNERS PLLC
Other - Org Name:ASAP
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:VAN DE WATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-209-1212
Mailing Address - Street 1:13188 N 103RD DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3066
Mailing Address - Country:US
Mailing Address - Phone:623-209-1212
Mailing Address - Fax:623-875-8761
Practice Address - Street 1:13188 N 103RD DR STE 200
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3066
Practice Address - Country:US
Practice Address - Phone:623-209-1212
Practice Address - Fax:623-875-8761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ24552Medicare PIN