Organization
ASSOCIATES IN SURGERY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAC A COOPER M.D. (PRESIDENT)
(219) 759-4577
Entity
Organization
Contact information
Practice address
3630 WILLOWCREEK RD, SUITE 3, PORTAGE, IN 46368-5075
(219) 759-4577
(219) 759-3564
Mailing address
3630 WILLOWCREEK RD, SUITE 3, PORTAGE, IN 46368-5075
(219) 759-4577
(219) 759-3564
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100209130B
—
IN
Enumeration date
10/19/2006
Last updated
08/19/2009
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