1750317020 NPI number — PLASTIC & HAND SURGERY ASSOCIATES, S.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 1750317020 NPI number — PLASTIC & HAND SURGERY ASSOCIATES, S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLASTIC & HAND SURGERY ASSOCIATES, S.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:
1750317020
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:
2900 FRANK SCOTT PKWY W
Provider Second Line Business Mailing Address:
#970
Provider Business Mailing Address City Name:
BELLEVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62223-5000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-235-8500
Provider Business Mailing Address Fax Number:
618-235-2929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 FRANK SCOTT PKWY W
Provider Second Line Business Practice Location Address:
#970
Provider Business Practice Location Address City Name:
BELLEVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62223-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-235-8500
Provider Business Practice Location Address Fax Number:
618-235-2929
Provider Enumeration Date:
06/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SALYAPONGSE
Authorized Official First Name:
AMORN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
618-235-8500

Provider Taxonomy Codes

  • Taxonomy code: 2082S0105X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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