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RENAISSANCE PLASTIC SURGERY PLLC NPI 1154342350


NPI Information

NPI: 1154342350
Provider Name: RENAISSANCE PLASTIC SURGERY PLLC
Classification: Plastic Surgery - 208200000X
Entity Type: Organization
Address:
2601 KENTUCKY AVE
STE 401
PADUCAH, KY
ZIP 42003
Phone: (270) 444-8200
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RENAISSANCE PLASTIC SURGERY PLLC is a plastic surgery in Paducah, KY. The provider is a plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well. RENAISSANCE PLASTIC SURGERY PLLC NPI is 1154342350. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2601 KENTUCKY AVE
STE 401
PADUCAH, KY
ZIP 42003-827
Phone: (270) 444-8200
Fax: (270) 444-8398

The provider's authorized official is Daniel M Tkach .
The authorized official title is Owner and has the following contact phone number (270) 444-8200.

The enumeration date for this NPI number is 7/22/2006 and was last updated on 12/3/2010.


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:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
12086S0122XSurgeryPlastic and Reconstructive SurgeryNo
22086S0105XSurgerySurgery of the HandNo
3208200000XPlastic SurgeryYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
16421MEDICARE ID-TYPE UNSPECIFIEDKENTUCKY
265907685MEDICAIDKENTUCKY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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