Provider Demographics
NPI:1861515355
Name:ADVA-MED SURGICAL ASSOCIATION INC
Entity type:Organization
Organization Name:ADVA-MED SURGICAL ASSOCIATION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MAGDALENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIETUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-636-8546
Mailing Address - Street 1:4201 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2615
Mailing Address - Country:US
Mailing Address - Phone:708-636-7870
Mailing Address - Fax:708-636-0264
Practice Address - Street 1:4201 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2615
Practice Address - Country:US
Practice Address - Phone:708-636-7870
Practice Address - Fax:708-636-0264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical