Provider Demographics
NPI:1275918054
Name:ADVANCED SURGICAL CONSULTANTS
Entity Type:Organization
Organization Name:ADVANCED SURGICAL CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WISHNEW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-642-4665
Mailing Address - Street 1:3628 CURBSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-8931
Mailing Address - Country:US
Mailing Address - Phone:214-642-4665
Mailing Address - Fax:
Practice Address - Street 1:3628 CURBSTONE WAY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-8931
Practice Address - Country:US
Practice Address - Phone:214-642-4665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8363208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX285930801Medicaid
TXTXB135797Medicare PIN