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General NPI Number Information
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NPI Number | 1336263821
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Entity Type | Organization
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Legal Business Name | ADVANTAGE SURGICAL LLC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4548 S BANNOCK ST
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City | ENGLEWOOD
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State | CO
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Zip | 80110-5706
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Country | US
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Telephone | 303-929-1090
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Fax |
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Provider Business Mailing Address
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Address Line | 4548 S BANNOCK ST
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City | ENGLEWOOD
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State | CO
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Zip | 80110-5706
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Country | US
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Telephone | 303-929-1090
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. JEFFERY ALLEN GARNER
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Credential | CFA SAC
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Telephone | 303-929-1090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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