Provider Demographics
NPI:1194321075
Name:ADVANCED SKIN AND MOHS SURGERY CLINICS, P.C.
Entity type:Organization
Organization Name:ADVANCED SKIN AND MOHS SURGERY CLINICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD, JD
Authorized Official - Phone:269-985-0021
Mailing Address - Street 1:2570 NILES RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-3203
Mailing Address - Country:US
Mailing Address - Phone:269-985-0021
Mailing Address - Fax:269-281-0281
Practice Address - Street 1:2570 NILES RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-3203
Practice Address - Country:US
Practice Address - Phone:269-985-0021
Practice Address - Fax:269-281-0281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty