Provider Demographics
NPI:1316545809
Name:ADVANCED SPECIALTY SURGERY
Entity Type:Organization
Organization Name:ADVANCED SPECIALTY SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RICCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-628-4243
Mailing Address - Street 1:PO BOX 358
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-0358
Mailing Address - Country:US
Mailing Address - Phone:610-628-4243
Mailing Address - Fax:215-628-2704
Practice Address - Street 1:124 N NARBERTH AVE
Practice Address - Street 2:
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-2211
Practice Address - Country:US
Practice Address - Phone:484-434-7500
Practice Address - Fax:484-434-7501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty