Provider Demographics
NPI:1053453134
Name:ADVANCED SURGICAL CONCEPTS LLC
Entity Type:Organization
Organization Name:ADVANCED SURGICAL CONCEPTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3890
Mailing Address - Street 1:14201 DALLAS PKWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-2916
Mailing Address - Country:US
Mailing Address - Phone:225-368-2322
Mailing Address - Fax:225-368-2275
Practice Address - Street 1:9118 BLUEBONNET CENTRE BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2975
Practice Address - Country:US
Practice Address - Phone:225-368-2330
Practice Address - Fax:225-368-2275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA131261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1507245Medicaid
LA1053453134OtherNPI
LA131OtherSTATE LICENSE
P00147168OtherRAILROAD MEDICARE/SRRGA
LA1053453134OtherNPI
LAP00147168Medicare PIN