1558556928 NPI number — PLASTIC SURGERY SPECIALISTS, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558556928 NPI number — PLASTIC SURGERY SPECIALISTS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLASTIC SURGERY SPECIALISTS, 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:
1558556928
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2009
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:
09/10/2007

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:  0416323 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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