=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083058150
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLIANCE SURGICAL ASSOCIATES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2013
-----------------------------------------------------
Last Update Date | 04/19/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 SW 12TH AVE STE 101
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33069-3298
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-366-5752
-----------------------------------------------------
Fax | 954-933-2657
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150 SW 12TH AVE STE 101
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33069-3298
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-366-5752
-----------------------------------------------------
Fax | 954-933-2657
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD/OWNER
-----------------------------------------------------
Name | ROBERT T GETTER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 954-366-5752
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | ME110843
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------