Provider Demographics
NPI:1407945926
Name:ADVANCED LAPAROSCOPIC BARIATRIC SURGERY ASSOCIATES
Entity Type:Organization
Organization Name:ADVANCED LAPAROSCOPIC BARIATRIC SURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-373-7699
Mailing Address - Street 1:426 PINE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-5201
Mailing Address - Country:US
Mailing Address - Phone:419-352-3067
Mailing Address - Fax:
Practice Address - Street 1:960 W WOOSTER ST
Practice Address - Street 2:SUITE 116
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2644
Practice Address - Country:US
Practice Address - Phone:419-373-7699
Practice Address - Fax:419-354-7430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.086946261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2510018Medicaid
OH2510018Medicaid
OHG78586Medicare UPIN