Provider Demographics
NPI:1245312586
Name:ASSOCIATES IN SURGERY, PC
Entity type:Organization
Organization Name:ASSOCIATES IN SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAC
Authorized Official - Middle Name:A
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-759-4577
Mailing Address - Street 1:3630 WILLOWCREEK RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-5075
Mailing Address - Country:US
Mailing Address - Phone:219-759-4577
Mailing Address - Fax:219-759-3564
Practice Address - Street 1:3630 WILLOWCREEK RD
Practice Address - Street 2:SUITE 3
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-5075
Practice Address - Country:US
Practice Address - Phone:219-759-4577
Practice Address - Fax:219-759-3564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100209130BMedicaid