Advanced Surgical Technology, LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

ADVANCED SURGICAL TECHNOLOGY, LLC

Practice address

4200 Williamson PL Ste 1a
Mount Vernon, IL 62864-6705

Phone

(618) 899-9195

Fax

(618) 918-7151

NPI assigned

Jun 30, 2023

Organization subpart

No

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

Authorized official

Name

Jennia Rensing

Title

Office Manager

Phone

(618) 899-9200

Specialties & licenses 1

Addresses

Other names 1

• AST Primary Care MT Vernon Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1688083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688083200000",
    "number": "1902583909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 WILLIAMSON PL STE 1A",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646705",
            "telephone_number": "618-899-9195",
            "fax_number": "618-918-7151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 WILLIAMSON PL STE 1A",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646705",
            "telephone_number": "618-899-9195",
            "fax_number": "618-918-7151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED SURGICAL TECHNOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-30",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A",
        "authorized_official_last_name": "RENSING",
        "authorized_official_first_name": "JENNIA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "618-899-9200"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AST Primary Care MT Vernon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Andrea Lynn Adams
• Bayly Lynn Adams, APRN
• Addus Healthcare, Inc
• Addus Healthcare, Inc.
• Advanced Internal Medicine, LLC
• Advanced Urologic Surgeons PC
• After Hours Immediate Care LLC
• Joon S Ahn, M.D.
• Ahuja Bariatric & Beyond
• Naresh Kumar Ahuja, MD

• All providers in Mount Vernon, IL
• Rural Health Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.