Healthcare Provider Details

I. General information

NPI: 1194778373
Provider Name (Legal Business Name): ADVANCED NEUROSURGERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1989 MIAMISBURG CENTERVILLE RD STE 304
CENTERVILLE OH
45459-3823
US

IV. Provider business mailing address

PO BOX 42255
CINCINNATI OH
45242-0255
US

V. Phone/Fax

Practice location:
  • Phone: 937-299-8242
  • Fax: 844-701-8968
Mailing address:
  • Phone: 937-299-8242
  • Fax: 844-701-8944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JAMAL M TAHA
Title or Position: OWNER / PRESIDENT
Credential: MD
Phone: 937-299-8242