Provider Demographics
NPI:1467588541
Name:ASAG, INC.
Entity Type:Organization
Organization Name:ASAG, INC.
Other - Org Name:AMBULATORY SURGERY ANESTHESIA GROUP. INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CRNA
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:N
Authorized Official - Last Name:STORK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:870-435-4477
Mailing Address - Street 1:PO BOX 434
Mailing Address - Street 2:
Mailing Address - City:GASSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72635-0434
Mailing Address - Country:US
Mailing Address - Phone:870-435-4477
Mailing Address - Fax:
Practice Address - Street 1:160 HWY 201 NORTH
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653
Practice Address - Country:US
Practice Address - Phone:870-508-2100
Practice Address - Fax:870-508-2150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F724OtherMEDICARE PROVIDER NUMBER