Provider Demographics
NPI:1225398480
Name:TRI STATE ADVANCED SURGERY CENTER, LLC.
Entity Type:Organization
Organization Name:TRI STATE ADVANCED SURGERY CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-559-2006
Mailing Address - Street 1:2596 INTERSTATE 55
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-2327
Mailing Address - Country:US
Mailing Address - Phone:870-559-2006
Mailing Address - Fax:870-559-2413
Practice Address - Street 1:2596 INTERSTATE 55
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-2327
Practice Address - Country:US
Practice Address - Phone:870-559-2006
Practice Address - Fax:870-559-2413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical