Provider Demographics
NPI:1871794800
Name:HAND & UPPER EXTREMITY CENTER
Entity type:Organization
Organization Name:HAND & UPPER EXTREMITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLAYINKA
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUNRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-296-3875
Mailing Address - Street 1:7989 W VIRGINIA DR # 105
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3765
Mailing Address - Country:US
Mailing Address - Phone:972-296-3875
Mailing Address - Fax:972-296-3575
Practice Address - Street 1:7989 W VIRGINIA DR # 105
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3765
Practice Address - Country:US
Practice Address - Phone:972-296-3875
Practice Address - Fax:972-296-3575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1174261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB25245Medicare UPIN
00R98NMedicare ID - Type Unspecified