NPIMap

Organization Active NPI

Asmsc-Valparaiso in PC

Doing business as Advanced Skin and Mohs Surgery Clinics

  • MOHS-Micrographic Surgery Physician
  • Mill Creek, IN
National Provider Identifier
1356932883
Registry record updated Jan 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
Legal business name
ASMSC-VALPARAISO IN PC
Doing business as
Advanced Skin and Mohs Surgery Clinics
Practice address
6445 E Division Rd
Mill Creek, IN 46365-9798
Phone
(269) 985-0021
NPI assigned
Jan 28, 2021
Last updated
Jan 28, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Clarence W Brown Jr., MD, JD
Title
Owner, Ceo, President
Phone
(269) 985-0021

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X
MOHS-Micrographic Surgery Physician 207ND0101X Primary
Dermatopathology Physician 207ND0900X
Clinical & Laboratory Dermatological Immunology Physician 207NI0002X
Dermatopathology (Pathology) Physician 207ZD0900X
Plastic Surgery Physician 208200000X

Addresses

Primary practice location

6445 E Division Rd
Mill Creek, IN 46365-9798

Mailing address

2570 Niles Rd
Saint Joseph, MI 49085-3203
Phone (269) 985-0021

Other names 1

  • Advanced Skin and Mohs Surgery Clinics Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611792000000",
    "number": "1356932883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2570 NILES RD",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490853203",
            "telephone_number": "269-985-0021",
            "fax_number": "269-281-0281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6445 E DIVISION RD",
            "city": "MILL CREEK",
            "state": "IN",
            "postal_code": "463659798",
            "telephone_number": "269-985-0021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASMSC-VALPARAISO IN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-28",
        "last_updated": "2021-01-28",
        "certification_date": "2021-01-28",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "CLARENCE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER, CEO, PRESIDENT",
        "authorized_official_telephone_number": "269-985-0021",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD, JD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NI0002X",
            "taxonomy_group": "",
            "desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZD0900X",
            "taxonomy_group": "",
            "desc": "Pathology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Skin and Mohs Surgery Clinics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mill Creek, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.