1356527477 NPI number — PLASTIC SURGERY CENTER, P.C.

Table of content: (NPI 1356527477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356527477 NPI number — PLASTIC SURGERY CENTER, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLASTIC SURGERY CENTER, P.C.
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:
Provider Other Organization Name Type Code:
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:
1356527477
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3385 DEXTER CT
Provider Second Line Business Mailing Address:
SUITE 115
Provider Business Mailing Address City Name:
DAVENPORT
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52807-3471
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-359-4777
Provider Business Mailing Address Fax Number:
563-359-4781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3385 DEXTER CT
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
DAVENPORT
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52807-3471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-359-4777
Provider Business Practice Location Address Fax Number:
563-359-4781
Provider Enumeration Date:
01/18/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PAUL
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
FRANCIS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
563-359-4777

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  33897 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 204E00000X , with the licence number: 07454 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208200000X , with the licence number: 33897 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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