Provider Demographics
NPI:1154694966
Name:ADVANTAGE SURGICAL ASSISTING
Entity type:Organization
Organization Name:ADVANTAGE SURGICAL ASSISTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHORTNESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-421-1191
Mailing Address - Street 1:222 PADDINGTON LN
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4533
Mailing Address - Country:US
Mailing Address - Phone:630-421-1191
Mailing Address - Fax:630-637-0233
Practice Address - Street 1:222 PADDINGTON LN
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-4533
Practice Address - Country:US
Practice Address - Phone:630-421-1191
Practice Address - Fax:630-637-0233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000042246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1881775880OtherBLUE CROSS