Provider Demographics
NPI:1720268840
Name:ADVANCED SURGICAL, LLC
Entity Type:Organization
Organization Name:ADVANCED SURGICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STOYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOKOCHAROV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-455-9410
Mailing Address - Street 1:1660 W MARKET ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-2536
Mailing Address - Country:US
Mailing Address - Phone:419-455-9410
Mailing Address - Fax:419-455-9414
Practice Address - Street 1:1660 W MARKET ST
Practice Address - Street 2:SUITE D
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883
Practice Address - Country:US
Practice Address - Phone:419-455-9410
Practice Address - Fax:419-455-9414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9350951Medicare PIN