Provider Demographics
NPI:1639648058
Name:PACIFIC HAND SURGERY CENTER
Entity Type:Organization
Organization Name:PACIFIC HAND SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAFNAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:671-646-3855
Mailing Address - Street 1:633 GOV CARLOS G CAMACHO RD STE 212
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3195
Mailing Address - Country:US
Mailing Address - Phone:671-646-4263
Mailing Address - Fax:671-649-2266
Practice Address - Street 1:633 GOV CARLOS G CAMACHO RD STE 212
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3195
Practice Address - Country:US
Practice Address - Phone:671-646-4263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
170804300OtherUS DOL
TXJ6266501Medicaid