Basic Information
| Provider Information | |||||||||
| NPI: | 1831644673 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTHSTATE PLASTIC SURGERY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8505 | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959278505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303455900 | ||||||||
| FaxNumber: | 5303455995 | ||||||||
| Practice Location | |||||||||
| Address1: | 1260 EAST AVE | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959261021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303455900 | ||||||||
| FaxNumber: | 5303455995 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2016 | ||||||||
| LastUpdateDate: | 08/22/2016 | ||||||||
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| AuthorizedOfficialLastName: | MYERS | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5303455900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NORTHSTATE PLASTIC SURGERY ASSOCIATES | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.