Provider Demographics
NPI:1659058659
Name:ADVANCED SURGICAL TECHNOLOGY, LLC
Entity Type:Organization
Organization Name:ADVANCED SURGICAL TECHNOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RENSING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-899-9200
Mailing Address - Street 1:28 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOYLETON
Mailing Address - State:IL
Mailing Address - Zip Code:62803-2000
Mailing Address - Country:US
Mailing Address - Phone:618-918-7777
Mailing Address - Fax:618-918-7782
Practice Address - Street 1:28 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HOYLETON
Practice Address - State:IL
Practice Address - Zip Code:62803-2000
Practice Address - Country:US
Practice Address - Phone:618-918-7777
Practice Address - Fax:618-918-7782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health