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?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty