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General NPI Number Information
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NPI Number | 1518241892
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Entity Type | Organization
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Legal Business Name | ADVANTAGE SURGICAL ASSISTANTS, INC.
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Dates
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Enumeration Date | 10/04/2011
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Last Update Date | 10/04/2011
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Provider Practice Location Address
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Address Line | 222 PADDINGTON LN
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City | BOLINGBROOK
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State | IL
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Zip | 60440-4533
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Country | US
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Telephone | 630-421-1191
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Fax | 630-364-2619
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Provider Business Mailing Address
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Address Line | PO BOX 1811
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City | BOLINGBROOK
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State | IL
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Zip | 60440-7534
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Country | US
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Telephone | 630-421-1191
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Fax | 630-364-2619
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Authorized Official
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Title or Position | REGISTERED SURGICAL ASSISTANT
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Name | RANDALL HAYES
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Credential | RSA
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Telephone | 630-421-1191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 238000042
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License Number State | IL
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