Provider Demographics
NPI:1861452310
Name:ASSOCIATE SURGEON NETWORK LLC
Entity type:Organization
Organization Name:ASSOCIATE SURGEON NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-874-4600
Mailing Address - Street 1:2901 SW 149TH AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4153
Mailing Address - Country:US
Mailing Address - Phone:954-874-4600
Mailing Address - Fax:786-594-5200
Practice Address - Street 1:1150 CAMPO SANO AVE
Practice Address - Street 2:SUITE
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-1174
Practice Address - Country:US
Practice Address - Phone:305-669-3320
Practice Address - Fax:305-669-3324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34734Medicare PIN