Provider Demographics
NPI:1336263821
Name:ADVANTAGE SURGICAL LLC
Entity type:Organization
Organization Name:ADVANTAGE SURGICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:CFA SAC
Authorized Official - Phone:303-929-1090
Mailing Address - Street 1:4548 S BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-5706
Mailing Address - Country:US
Mailing Address - Phone:303-929-1090
Mailing Address - Fax:
Practice Address - Street 1:4548 S BANNOCK ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-5706
Practice Address - Country:US
Practice Address - Phone:303-929-1090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty