RIVERSIDE PLASTIC SURGERY LLC NPI 1255766788

NPI Information

RIVERSIDE PLASTIC SURGERY LLC is a plastic and reconstructive surgery surgery in Greenville, SC. The provider is a surgeon who specializes in plastic and reconstructive surgery. RIVERSIDE PLASTIC SURGERY LLC NPI is 1255766788. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

24 MEMORIAL MEDICAL DR
GREENVILLE, SC
ZIP 29605
Phone: (864) 697-2009
Fax: (864) 697-2009

The provider's authorized official is Brent Moister .
The authorized official title is Owner and has the following contact phone number (864) 697-2009.

The CLIA number assigned to this NPI record is 42D2273155 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/3/2013 and was last updated on 7/18/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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