Provider Demographics
NPI:1215024484
Name:ACCESS SURGICAL ASSISTANTS, INC
Entity Type:Organization
Organization Name:ACCESS SURGICAL ASSISTANTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:PIOVESAN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:541-290-9639
Mailing Address - Street 1:66599 QUAIL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-9491
Mailing Address - Country:US
Mailing Address - Phone:541-290-9639
Mailing Address - Fax:541-751-0739
Practice Address - Street 1:66599 QUAIL RD
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-9491
Practice Address - Country:US
Practice Address - Phone:541-290-9639
Practice Address - Fax:541-751-0739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00885363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR=========OtherTAX ID
ORP74211Medicare UPIN
ORR137052Medicare PIN