Basic Information
| Provider Information | |||||||||
| NPI: | 1114373040 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YOUR EXTRA HANDS SURGICAL SERVICES PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1604 VISA DR STE 1 | ||||||||
| Address2: | |||||||||
| City: | NORMAL | ||||||||
| State: | IL | ||||||||
| PostalCode: | 617612195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3096842329 | ||||||||
| FaxNumber: | 3094547348 | ||||||||
| Practice Location | |||||||||
| Address1: | 1355 37TH ST STE 302 | ||||||||
| Address2: | |||||||||
| City: | VERO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329607320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7725693011 | ||||||||
| FaxNumber: | 7725693036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2016 | ||||||||
| LastUpdateDate: | 10/19/2018 | ||||||||
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| AuthorizedOfficialLastName: | ATWATER | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3098464716 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZC0007X | Y | 193400000X SINGLE SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Certified First Assistant |
No ID Information.