Provider Demographics
NPI:1942211065
Name:MIDWEST PLASTIC & HAND SURGERY INC
Entity Type:Organization
Organization Name:MIDWEST PLASTIC & HAND SURGERY INC
Other - Org Name:TIMOTHY R OCONNELL MD INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ROGERS
Authorized Official - Last Name:OCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-991-2151
Mailing Address - Street 1:621 SOUTH NEW BALLAS ROAD
Mailing Address - Street 2:SUITE 6003B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-991-2151
Mailing Address - Fax:314-991-2742
Practice Address - Street 1:621 SOUTH NEW BALLAS ROAD
Practice Address - Street 2:SUITE 6003B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-991-2151
Practice Address - Fax:314-991-2742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1164Medicare PIN