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ALLOPLASTIC RECONSTRUCTION NPI 1962805812


NPI Information

NPI: 1962805812
Provider Name: ALLOPLASTIC RECONSTRUCTION

Doing Business As: THE CENTER FOR ALLOPLASTIC FACIAL RECONSTRUCTION

Classification: Anaplastologist - 229N00000X
Entity Type: Organization
Address:
6 W GE PATTERSON AVE
SUITE 102
MEMPHIS, TN
ZIP 38103
Phone: (901) 410-5375
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ALLOPLASTIC RECONSTRUCTION is an anaplastologist in Memphis, TN. The provider is an anaplastologist is a professional who creates prostheses for the face and body. Patients treated include those missing anatomy due to cancer, traumatic injury, or birth differences. Generally, there are no state licensing requirements for anaplastologists. Certification specific to anaplastology is provided through the Board for Certified Clinical Anaplastology (BCCA) with a credential title of Certified Clinical Anaplastologist (CCA). ALLOPLASTIC RECONSTRUCTION NPI is 1962805812. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As The Center For Alloplastic Facial Reconstruction.

The provider's business location address is:

6 W GE PATTERSON AVE
SUITE 102
MEMPHIS, TN
ZIP 38103-413
Phone: (901) 410-5375
Fax: (800) 977-4149

The provider's authorized official is Michael D Kaczkowski .
The authorized official title is President and has the following contact phone number (501) 265-0100.

The enumeration date for this NPI number is 10/7/2014 and was last updated on 1/9/2015.


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
1156FX1700XTechnician/TechnologistOcularistNo
2335E00000XProsthetic/Orthotic SupplierOPP00038ARKANSASNo
3229N00000XAnaplastologistYes

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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