Basic Information
| Provider Information | |||||||||
| NPI: | 1922520915 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HAYES HAND SURGERY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6375 WHITE TAIL DR | ||||||||
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| City: | EAU CLAIRE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 547019161 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1120 PINE ST | ||||||||
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| City: | STANLEY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 547681297 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7156445571 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2017 | ||||||||
| LastUpdateDate: | 07/11/2017 | ||||||||
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| AuthorizedOfficialLastName: | HAYES | ||||||||
| AuthorizedOfficialFirstName: | EDWARD | ||||||||
| AuthorizedOfficialMiddleName: | PATRICK | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7156445571 | ||||||||
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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 | 207X00000X | 36946 | WI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1922194976 | 05 | WI | MEDICAID |