Basic Information
| Provider Information | |||||||||
| NPI: | 1801055066 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PLASTIC SURGERY CONSULTANTS, LTD. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3300 EDINBOROUGH WAY | ||||||||
| Address2: | SUITE 505 | ||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554355923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9527466767 | ||||||||
| FaxNumber: | 9527466768 | ||||||||
| Practice Location | |||||||||
| Address1: | 3300 EDINBOROUGH WAY | ||||||||
| Address2: | SUITE 505 | ||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554355923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9527466767 | ||||||||
| FaxNumber: | 9527466768 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2008 | ||||||||
| LastUpdateDate: | 06/03/2008 | ||||||||
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| AuthorizedOfficialLastName: | SUPER | ||||||||
| AuthorizedOfficialFirstName: | JANE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CLINIC ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9527466767 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
No ID Information.