Provider Demographics
NPI:1114980034
Name:ADVANCED LAPAROSCOPIC SURGERY ASSOCIATES MEDICAL GROUP INC
Entity Type:Organization
Organization Name:ADVANCED LAPAROSCOPIC SURGERY ASSOCIATES MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HIGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-228-5448
Mailing Address - Street 1:PO BOX 28947
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-8947
Mailing Address - Country:US
Mailing Address - Phone:559-228-5448
Mailing Address - Fax:559-224-3920
Practice Address - Street 1:205 E RIVER PARK CIR
Practice Address - Street 2:#460
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-1571
Practice Address - Country:US
Practice Address - Phone:559-261-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53771208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0098660Medicaid
CAZZZ26512ZOtherMEDICARE