Provider Demographics
NPI:1366499188
Name:ADVANCED COLORECTAL ASSOCIATES L.L.C
Entity type:Organization
Organization Name:ADVANCED COLORECTAL ASSOCIATES L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:URVASHI
Authorized Official - Middle Name:
Authorized Official - Last Name:SANGHAVI-SAHA
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:405-749-4201
Mailing Address - Street 1:4200 W MEMORIAL RD STE 612
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8387
Mailing Address - Country:US
Mailing Address - Phone:405-749-4201
Mailing Address - Fax:405-749-4208
Practice Address - Street 1:4200 W MEMORIAL RD STE 612
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8387
Practice Address - Country:US
Practice Address - Phone:405-749-4201
Practice Address - Fax:405-749-4208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKDR. SAHA'S -22328208C00000X
OKDR. WOODWARD'S-6976208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100004790BMedicaid
OK100092670BMedicaid
OK100004790BMedicaid
OK100522039Medicare PIN
OKD35427Medicare UPIN
OKH41946Medicare UPIN
OK100092670BMedicaid