=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619063245
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED SURGICAL ASSOCIATES, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 10/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1721 E 19TH AVE SUITE 404
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-861-4505
-----------------------------------------------------
Fax | 303-861-9036
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1721 E 19TH AVE SUITE 404
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-861-4505
-----------------------------------------------------
Fax | 303-861-9036
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | JANE HOVANEC-BROWN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 720-934-2561
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------