1780897272 NPI number — HILTON HEAD ISLAND PLASTIC SURGERY, LLC

Table of content: MALLORY ALISE WORREL (NPI 1770288128)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780897272 NPI number — HILTON HEAD ISLAND PLASTIC SURGERY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HILTON HEAD ISLAND PLASTIC SURGERY, LLC
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:
1780897272
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35 BILL FRIES DR
Provider Second Line Business Mailing Address:
ISLAND MEDICAL PLAZA, BLDG E
Provider Business Mailing Address City Name:
HILTON HEAD ISLAND
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29926-2730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-681-4088
Provider Business Mailing Address Fax Number:
843-689-3742

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 BILL FRIES DR
Provider Second Line Business Practice Location Address:
ISLAND MEDICAL PLAZA, BLDG E
Provider Business Practice Location Address City Name:
HILTON HEAD ISLAND
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29926-2730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-681-4088
Provider Business Practice Location Address Fax Number:
843-689-3742
Provider Enumeration Date:
05/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LAUGHLIN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
ABEL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
843-681-4088

Provider Taxonomy Codes

  • Taxonomy code: 2086S0105X , with the licence number:  8695 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0122X , with the licence number: 8695 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 086953 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com