Provider Demographics
NPI:1417037698
Name:RICHARD E OBRINGER PAC PROF CORP
Entity Type:Organization
Organization Name:RICHARD E OBRINGER PAC PROF CORP
Other - Org Name:ADVANCED SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-499-7296
Mailing Address - Street 1:11413 PERUGINO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-1533
Mailing Address - Country:US
Mailing Address - Phone:702-499-7296
Mailing Address - Fax:
Practice Address - Street 1:11413 PERUGINO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89138-1533
Practice Address - Country:US
Practice Address - Phone:702-499-7296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100503895Medicaid
NVP07516Medicare UPIN
NVV40256Medicare PIN