Provider Demographics
NPI:1194778373
Name:ADVANCED NEUROSURGERY INC
Entity type:Organization
Organization Name:ADVANCED NEUROSURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:TAHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-229-8242
Mailing Address - Street 1:PO BOX 42255
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-0255
Mailing Address - Country:US
Mailing Address - Phone:937-299-8242
Mailing Address - Fax:844-701-8944
Practice Address - Street 1:3533 SOUTHERN BLVD
Practice Address - Street 2:STE 3000
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1280
Practice Address - Country:US
Practice Address - Phone:937-299-8242
Practice Address - Fax:937-229-8245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2914841Medicaid
OH6365600001Medicare NSC
OHDH0428Medicare PIN
OH9331671Medicare PIN