1215087903 NPI number — TPG PLLC

Table of content: (NPI 1215087903)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215087903 NPI number — TPG PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TPG PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NEW HORIZONS PLASTAIC SURGERY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215087903
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2605 KENTUCKY AVE
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
PADUCAH
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42003-3800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-575-0555
Provider Business Mailing Address Fax Number:
270-575-3005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2605 KENTUCKY AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
PADUCAH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42003-3800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-575-0555
Provider Business Practice Location Address Fax Number:
270-575-3005
Provider Enumeration Date:
01/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GINESTRA
Authorized Official First Name:
TODD
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
270-575-0555

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  36025 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1902832108 . This is a "CELIA TOON-PA-C INDIVIDUA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1063151 . This is a "CELAI TOON NCCPA CERTI" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1598791089 . This is a "INDIVIDUAL NPI #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".