Healthcare Provider Details

I. General information

NPI: 1871798918
Provider Name (Legal Business Name): HANDS ON SURGICAL ASSIST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2434 CHESTNUT LN
MORRIS IL
60450-1038
US

IV. Provider business mailing address

PO BOX 309
MONEE IL
60449-0309
US

V. Phone/Fax

Practice location:
  • Phone: 815-252-7453
  • Fax:
Mailing address:
  • Phone: 708-534-2168
  • Fax: 708-328-3668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number238000090
License Number StateIL

VIII. Authorized Official

Name: DAWN M INGRAM
Title or Position: OWNER
Credential: RSA-C
Phone: 815-252-7453