Provider Demographics
NPI:1649957648
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 1:309 W SAINT LOUIS ST STE A
Mailing Address - Street 2:
Mailing Address - City:WEST FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:62896-2047
Mailing Address - Country:US
Mailing Address - Phone:618-932-9313
Mailing Address - Fax:618-932-9314
Practice Address - Street 1:309 W SAINT LOUIS ST STE A
Practice Address - Street 2:
Practice Address - City:WEST FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:62896-2047
Practice Address - Country:US
Practice Address - Phone:618-932-9313
Practice Address - Fax:618-932-9314
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