Provider Demographics
NPI:1154314557
Name:ADVANCED SURGICAL ORTHOPEDICS, PS
Entity Type:Organization
Organization Name:ADVANCED SURGICAL ORTHOPEDICS, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:VERHOOGEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-456-8550
Mailing Address - Street 1:PO BOX 405
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99210-0405
Mailing Address - Country:US
Mailing Address - Phone:509-456-8550
Mailing Address - Fax:509-838-6562
Practice Address - Street 1:105 W 8TH AVE
Practice Address - Street 2:SUITE 454E
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2302
Practice Address - Country:US
Practice Address - Phone:509-456-8550
Practice Address - Fax:509-838-6562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADC7326OtherRR MEDICARE
WA8850870Medicare PIN