Advanced Surgical Assistants LLC

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Legal business name

ADVANCED SURGICAL ASSISTANTS LLC

Practice address

1924 30TH Ave Ste a
Gulfport, MS 39501-4534

Phone

(228) 206-7634

Fax

(228) 206-4523

NPI assigned

Nov 11, 2015

Last updated

Nov 11, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Robert Lee Gillum Jr., SFA

Title

Surgical First Assistant

Phone

(228) 343-3044

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1447200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447200000000",
    "number": "1487027504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1924 30TH AVE STE A",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395014534",
            "telephone_number": "228-206-7634",
            "fax_number": "228-206-4523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1924 30TH AVE STE A",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395014534",
            "telephone_number": "228-206-7634",
            "fax_number": "228-206-4523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED SURGICAL ASSISTANTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-11",
        "last_updated": "2015-11-11",
        "status": "A",
        "authorized_official_last_name": "GILLUM",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "SURGICAL FIRST ASSISTANT",
        "authorized_official_telephone_number": "228-343-3044",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "SFA"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Surgical Physician Assistant in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Surgical Physician Assistant in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2015; 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.