PREMIERE PLASTIC COSMETIC AND LASER SURGERY CENTER LLC NPI 1770631392

NPI Information

NPI: 1770631392
Provider Name: PREMIERE PLASTIC COSMETIC AND LASER SURGERY CENTER LLC
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

Address:
3533 SOUTHERN BLVD
SUITE 4400
KETTERING, OH
ZIP 45429
Phone: (937) 294-9255
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PREMIERE PLASTIC COSMETIC AND LASER SURGERY CENTER LLC is an ambulatory surgical clinic center in Kettering, OH. PREMIERE PLASTIC COSMETIC AND LASER SURGERY CENTER LLC NPI is 1770631392. The provider is registered as an organization entity type.

The provider's business location address is:

3533 SOUTHERN BLVD
SUITE 4400
KETTERING, OH
ZIP 45429-264
Phone: (937) 294-9255
Fax: (937) 294-9256

The provider's authorized official is Thomas Percy .
The authorized official title is President and has the following contact phone number (937) 294-9255.

The enumeration date for this NPI number is 1/8/2007 and was last updated on 12/28/2012.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical	037634	OHIO	Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	3612351	MEDICARE PIN	OHIO
2	3035227	MEDICAID	OHIO

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

NPI Synchronization or Removal

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