1063549178 NPI number — PLASTIC SURGERY CENTER, P.A.

Table of content: DR. EVELYN HSIEH DONROE M.D., M.P.H. (NPI 1225204936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063549178 NPI number — PLASTIC SURGERY CENTER, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLASTIC SURGERY CENTER, P.A.
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:
1063549178
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1920 CHADWICK DR
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39204-3471
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-373-3730
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1920 CHADWICK DR
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39204-3471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-373-3730
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GORMAN
Authorized Official First Name:
DIANA
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRES- OFFICE MANAGER
Authorized Official Telephone Number:
601-373-3730

Provider Taxonomy Codes

  • Taxonomy code: 2086S0122X , with the licence number:  08261 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 05959573 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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