Healthcare Provider Details

I. General information

NPI: 1538324736
Provider Name (Legal Business Name): MEXICO SURGICAL ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 E SUMMIT ST SUITE F
MEXICO MO
65265-3298
US

IV. Provider business mailing address

626 E SUMMIT ST SUITE F
MEXICO MO
65265-3298
US

V. Phone/Fax

Practice location:
  • Phone: 573-581-2228
  • Fax: 573-581-4995
Mailing address:
  • Phone: 573-581-2228
  • Fax: 573-581-4995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number108014
License Number StateMO

VIII. Authorized Official

Name: DR. PETER D PERLL
Title or Position: PRESIDENT
Credential: MD
Phone: 573-581-2228