Provider Demographics
NPI:1154502466
Name:YOUR EXTRA HANDS SURGICAL SERVICES
Entity Type:Organization
Organization Name:YOUR EXTRA HANDS SURGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:FALLS
Authorized Official - Suffix:
Authorized Official - Credentials:
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:309-846-4716
Mailing Address - Fax:309-454-7348
Practice Address - Street 1:1604 VISA DR.
Practice Address - Street 2:STE. 2
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761
Practice Address - Country:US
Practice Address - Phone:309-846-4716
Practice Address - Fax:309-454-7348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZC0007X
IL248.000.284171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty