Provider Demographics
NPI:1841444114
Name:ASSOCIATED SURGEONS AND PHYSICIANS, LLC
Entity type:Organization
Organization Name:ASSOCIATED SURGEONS AND PHYSICIANS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-432-4400
Mailing Address - Street 1:2518 E DUPONT RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1675
Mailing Address - Country:US
Mailing Address - Phone:260-432-4400
Mailing Address - Fax:260-969-6884
Practice Address - Street 1:11141 PARKVIEW PLAZA DR
Practice Address - Street 2:SUITE 305
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1713
Practice Address - Country:US
Practice Address - Phone:260-484-9611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSOCIATED SURGEONS AND PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN667640Medicare PIN
OH9365921Medicare PIN
INCA7015OtherRAILROAD
OH9365921Medicare PIN
OH0270371Medicaid