Provider Demographics
NPI:1073793063
Name:ADVANCED SURGICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:ADVANCED SURGICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HADI
Authorized Official - Middle Name:ASSAD
Authorized Official - Last Name:SHALHOUB
Authorized Official - Suffix:
Authorized Official - Credentials:D,O
Authorized Official - Phone:772-581-8900
Mailing Address - Street 1:3660 20TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-2408
Mailing Address - Country:US
Mailing Address - Phone:772-581-8900
Mailing Address - Fax:772-581-4478
Practice Address - Street 1:13835 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3232
Practice Address - Country:US
Practice Address - Phone:772-581-8900
Practice Address - Fax:772-581-4478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 7619208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG53205Medicare UPIN
FLK2833Medicare PIN