FACIAL PLASTIC & LASER SURGERY is a clinic center in Peoria, IL. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). FACIAL PLASTIC & LASER SURGERY NPI is 1194888677. The provider is registered as an organization entity type.
The provider Other Name Is Facial Plastic & Laser Surgery Center, Llc.
The provider's business location address is:
7301 N KNOXVILLE AVE
PEORIA, IL
ZIP 61614-017
Phone: (309) 589-3233
Fax: (309) 689-0312
The provider's authorized official is Robert J Tudor .
The authorized official title is Chief Executive Officer and has the following contact phone number (309) 589-8053.
The CLIA number assigned to this NPI record is 14D1057126 - ambulatory surgery center with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 12/18/2006 and was last updated on 7/21/2022.