Provider Demographics
NPI:1851561484
Name:ADVANCED ORTHOPAEDIC SURGERY, LLC
Entity Type:Organization
Organization Name:ADVANCED ORTHOPAEDIC SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KAUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-352-7768
Mailing Address - Street 1:647 BIENVILLE CIR
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-5744
Mailing Address - Country:US
Mailing Address - Phone:318-352-7768
Mailing Address - Fax:318-357-3661
Practice Address - Street 1:647 BIENVILLE CIR
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5744
Practice Address - Country:US
Practice Address - Phone:318-352-7768
Practice Address - Fax:318-357-3661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15580R207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1468479Medicaid
LA1468479Medicaid
LAH15685Medicare UPIN