Healthcare Provider Details

I. General information

NPI: 1700062486
Provider Name (Legal Business Name): PERFECT HANDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2008
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2702 PAOLI PIKE APT 35
NEW ALBANY IN
47150-5139
US

IV. Provider business mailing address

4527 JOSHUA CT
WEST LAFAYETTE IN
47906-8670
US

V. Phone/Fax

Practice location:
  • Phone: 219-742-8718
  • Fax:
Mailing address:
  • Phone: 765-807-5255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY ALLEN PRATER
Title or Position: CERTIFIED SURGICAL TECHNITION
Credential: CST
Phone: 219-742-8718