Provider Demographics
NPI:1538324736
Name:MEXICO SURGICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:MEXICO SURGICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:D
Authorized Official - Last Name:PERLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-581-2228
Mailing Address - Street 1:626 E SUMMIT ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-3298
Mailing Address - Country:US
Mailing Address - Phone:573-581-2228
Mailing Address - Fax:573-581-4995
Practice Address - Street 1:626 E SUMMIT ST
Practice Address - Street 2:SUITE F
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-3298
Practice Address - Country:US
Practice Address - Phone:573-581-2228
Practice Address - Fax:573-581-4995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108014208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207968819Medicaid
MO207968819Medicaid