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General NPI Number Information
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NPI Number | 1801852520
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Entity Type | Organization
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Legal Business Name | ADVANCED HEALTHCARE SURGICAL CENTER, LLC
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Dates
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Enumeration Date | 04/21/2006
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Last Update Date | 09/02/2008
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Provider Practice Location Address
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Address Line | 2002 KANELL BLVD
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-3967
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Country | US
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Telephone | 573-778-9209
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Fax | 573-778-1647
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Provider Business Mailing Address
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Address Line | 2002 KANELL BLVD
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-3967
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Country | US
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Telephone | 573-778-0020
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Fax | 573-778-1647
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Authorized Official
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Title or Position | CHAIRMAN/AUTHORIZED OFFICIAL
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Name | JOHN M HOJA
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Credential | M.D.
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Telephone | 573-778-0020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 123-2
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License Number State | MO
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