Provider Demographics
NPI:1619063245
Name:ADVANCED SURGICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:ADVANCED SURGICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOVANEC-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-934-2561
Mailing Address - Street 1:1721 E 19TH AVE
Mailing Address - Street 2:SUITE 404
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218
Mailing Address - Country:US
Mailing Address - Phone:303-861-4505
Mailing Address - Fax:303-861-9036
Practice Address - Street 1:1721 E 19TH AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218
Practice Address - Country:US
Practice Address - Phone:303-861-4505
Practice Address - Fax:303-861-9036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04013579Medicaid
THF2808OtherBC/BS GROUP
CO04013579Medicaid
F2808Medicare ID - Type UnspecifiedMEDICARE GROUP