| Oral Surgery Group Of Evansville, Inc | |
|
550 W Virginia St Evansville IN 47710-1614 | |
| (812) 425-5194 | |
| (812) 426-9984 |
| Full Name | Oral Surgery Group Of Evansville, Inc |
|---|---|
| Speciality | Dentist |
| Location | 550 W Virginia St, Evansville, Indiana |
| Authorized Official Name and Position | Karen L Kellams (PRACTICE MANAGER) |
| Authorized Official Contact | 8124255194 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Oral Surgery Group Of Evansville, Inc 550 W Virginia St Evansville IN 47710-1614 Ph: (812) 425-5194 | Oral Surgery Group Of Evansville, Inc 550 W Virginia St Evansville IN 47710-1614 Ph: (812) 425-5194 |
| NPI Number | 1467506188 |
|---|---|
| Provider Enumeration Date | 01/22/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 5991880106 |
|---|---|
| Medicare Enrollment ID | O20080312000517 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467506188 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 54000277A (Indiana) | Primary |
| Provider Name | David E Yates |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1215084413 PECOS PAC ID: 7315988540 Enrollment ID: I20080312000569 |
| Provider Name | Randall S Edwards |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1871751644 PECOS PAC ID: 7416096359 Enrollment ID: I20091205000093 |
| Provider Name | David L Hayhurst |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1386791580 PECOS PAC ID: 5890870018 Enrollment ID: I20111108000470 |
| Provider Name | Paul K Pogue |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1609923804 PECOS PAC ID: 4981789104 Enrollment ID: I20111128000561 |
| Provider Name | Stephen H Troyer |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1952455743 PECOS PAC ID: 2163507377 Enrollment ID: I20111202000605 |
| Provider Name | William R Farnsworth |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1790813293 PECOS PAC ID: 3173797370 Enrollment ID: I20140822000419 |
| Provider Name | Robert C Shumate |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1255691085 PECOS PAC ID: 5294092391 Enrollment ID: I20171128001258 |
| Provider Name | Mitchell I Troyer |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1518387828 PECOS PAC ID: 0648509133 Enrollment ID: I20190909002452 |
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