Provider Demographics
NPI:1720237431
Name:ADVANCED SURGICAL ASSISTANTS LLC
Entity type:Organization
Organization Name:ADVANCED SURGICAL ASSISTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DEMASTERS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:480-285-4890
Mailing Address - Street 1:2074 E HONEYSUCKLE PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-2315
Mailing Address - Country:US
Mailing Address - Phone:480-285-4890
Mailing Address - Fax:
Practice Address - Street 1:2074 E HONEYSUCKLE PL
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-2315
Practice Address - Country:US
Practice Address - Phone:480-285-4890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3777363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty