Provider Demographics
NPI:1912249939
Name:HAND AND MICROSURGERY ASSOCIATES, LLC
Entity type:Organization
Organization Name:HAND AND MICROSURGERY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETRO
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:417-621-9000
Mailing Address - Street 1:2727 E 32ND ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3164
Mailing Address - Country:US
Mailing Address - Phone:417-621-9000
Mailing Address - Fax:417-621-9002
Practice Address - Street 1:2727 E 32ND ST
Practice Address - Street 2:SUITE A
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3164
Practice Address - Country:US
Practice Address - Phone:417-621-9000
Practice Address - Fax:417-621-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-18
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2A49208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty