Provider Demographics
NPI:1114373040
Name:YOUR EXTRA HANDS SURGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:YOUR EXTRA HANDS SURGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ATWATER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-846-4716
Mailing Address - Street 1:1604 VISA DR STE 1
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-2195
Mailing Address - Country:US
Mailing Address - Phone:309-684-2329
Mailing Address - Fax:309-454-7348
Practice Address - Street 1:1355 37TH ST STE 302
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7320
Practice Address - Country:US
Practice Address - Phone:772-569-3011
Practice Address - Fax:772-569-3036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-10
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty