1649453945 NPI number — PLASTIC SURGERY SPECIALISTS PC

Table of content: (NPI 1649453945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649453945 NPI number — PLASTIC SURGERY SPECIALISTS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLASTIC SURGERY SPECIALISTS PC
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:
1649453945
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
621 W 50TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64112-2314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-531-0453
Provider Business Mailing Address Fax Number:
816-531-2033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8701 TROOST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64131-2767
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-531-0453
Provider Business Practice Location Address Fax Number:
816-531-2033
Provider Enumeration Date:
12/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LOTUACO
Authorized Official First Name:
GAMALIEL
Authorized Official Middle Name:
GO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
816-531-0453

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  33133 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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