Provider Demographics
NPI:1831876838
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 1:1297 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CARLYLE
Mailing Address - State:IL
Mailing Address - Zip Code:62231-1718
Mailing Address - Country:US
Mailing Address - Phone:618-227-7229
Mailing Address - Fax:618-227-9275
Practice Address - Street 1:1297 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CARLYLE
Practice Address - State:IL
Practice Address - Zip Code:62231-1718
Practice Address - Country:US
Practice Address - Phone:618-227-7229
Practice Address - Fax:618-227-9275
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