MEDICARE: YOUR EXTRA HANDS SURGICAL SERVICES PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant

General Provider Information

NPI Number	:	1114373040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR EXTRA HANDS SURGICAL SERVICES PLLC

Provider Business Mailing Address
First Line	:	1604 VISA DR STE 1
Second Line	:
City	:	NORMAL
State	:	IL
Zip	:	61761-2195
Country	:	US
Telephone Number	:	309-684-2329
Fax Number	:	309-454-7348

Provider Business Practice Location Address
First Line	:	1355 37TH ST STE 302
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-7320
Country	:	US
Telephone Number	:	772-569-3011
Fax Number	:	772-569-3036

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN ATWATER
Credential	:	MD
Telephone Number	:	309-846-4716

Provider Enumeration Date	:	05/10/2016
Last Update Date	:	10/19/2018

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