Healthcare Provider Details

I. General information

NPI: 1700242971
Provider Name (Legal Business Name): ADVANCE SURGICAL INSTRUMENTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 11/28/2020
Certification Date: 11/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 W BOUGHTON RD STE B
BOLINGBROOK IL
60440-1800
US

IV. Provider business mailing address

402 W BOUGHTON RD STE B
BOLINGBROOK IL
60440-1800
US

V. Phone/Fax

Practice location:
  • Phone: 312-549-9903
  • Fax: 312-549-9904
Mailing address:
  • Phone: 312-549-9903
  • Fax: 312-549-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: AMJAD KHAWAJA
Title or Position: MANAGER
Credential:
Phone: 312-549-9903