Basic Information
Provider Information | |||||||||
NPI: | 1033643051 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | PRECISION HAND SURGERY PA | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5959 GATEWAY BLVD W | ||||||||
Address2: | SUITE 120 | ||||||||
City: | EL PASO | ||||||||
State: | TX | ||||||||
PostalCode: | 799253331 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9157791716 | ||||||||
FaxNumber: | 9157716496 | ||||||||
Practice Location | |||||||||
Address1: | 12770 EDGEMERE BLVD | ||||||||
Address2: | BLDG F | ||||||||
City: | EL PASO | ||||||||
State: | TX | ||||||||
PostalCode: | 799384568 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9152494000 | ||||||||
FaxNumber: | 9152065949 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/17/2017 | ||||||||
LastUpdateDate: | 07/31/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MITCHELL | ||||||||
AuthorizedOfficialFirstName: | JUSTIN | ||||||||
AuthorizedOfficialMiddleName: | S | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
AuthorizedOfficialTelephone: | 9152494000 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | DO | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0106X | P8276 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
No ID Information.