Provider Demographics
NPI:1821048448
Name:ADVANCED SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:ADVANCED SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:BALDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-347-3900
Mailing Address - Street 1:2376 CYPRESS CIR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-8964
Mailing Address - Country:US
Mailing Address - Phone:843-347-3900
Mailing Address - Fax:843-347-3930
Practice Address - Street 1:2376 CYPRESS CIR
Practice Address - Street 2:SUITE 103
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8964
Practice Address - Country:US
Practice Address - Phone:843-347-3900
Practice Address - Fax:843-347-3930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8031Medicare PIN