Provider Demographics
NPI: | 1952004863 |
---|---|
Name: | ADVANCED SURGICAL AND RESTORATIVE CARE LLC |
Entity Type: | Organization |
Organization Name: | ADVANCED SURGICAL AND RESTORATIVE CARE LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CNO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | EMILY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MOSES |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 715-930-1937 |
Mailing Address - Street 1: | 1470 RIVERS EDGE TRL STE B |
Mailing Address - Street 2: | |
Mailing Address - City: | ALTOONA |
Mailing Address - State: | WI |
Mailing Address - Zip Code: | 54720-2755 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 715-930-1937 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1470 RIVERS EDGE TRL STE B |
Practice Address - Street 2: | |
Practice Address - City: | ALTOONA |
Practice Address - State: | WI |
Practice Address - Zip Code: | 54720-2755 |
Practice Address - Country: | US |
Practice Address - Phone: | 715-930-1937 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-03-22 |
Last Update Date: | 2023-03-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | Group - Single Specialty |