Provider Demographics
NPI:1386753200
Name:ADVANCED SURGICAL ASSOCIATES, PC
Entity type:Organization
Organization Name:ADVANCED SURGICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMSHIDI-NEZHAD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-604-0690
Mailing Address - Street 1:3330 NW 56TH ST
Mailing Address - Street 2:STE 208
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112
Mailing Address - Country:US
Mailing Address - Phone:405-604-0690
Mailing Address - Fax:405-604-0689
Practice Address - Street 1:3330 NW 56TH ST.
Practice Address - Street 2:STE 208
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:405-604-0690
Practice Address - Fax:405-604-0689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty