MEDICARE: ACCESS SURGICAL ASSISTANTS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	PA00885	OR

General Provider Information

NPI Number	:	1215024484
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCESS SURGICAL ASSISTANTS, INC

Provider Business Mailing Address
First Line	:	66599 QUAIL RD
Second Line	:
City	:	NORTH BEND
State	:	OR
Zip	:	97459-9491
Country	:	US
Telephone Number	:	541-290-9639
Fax Number	:	541-751-0739

Provider Business Practice Location Address
First Line	:	66599 QUAIL RD
Second Line	:
City	:	NORTH BEND
State	:	OR
Zip	:	97459-9491
Country	:	US
Telephone Number	:	541-290-9639
Fax Number	:	541-751-0739

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ALDO J PIOVESAN
Credential	:	PA-C
Telephone Number	:	541-290-9639

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/31/2008

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