Provider Demographics
NPI:1023357639
Name:THE PLASTIC SURGERY GROUP,PC
Entity Type:Organization
Organization Name:THE PLASTIC SURGERY GROUP,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-756-7134
Mailing Address - Street 1:901 RIVERFRONT PARKWAY
Mailing Address - Street 2:STE 100
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-2102
Mailing Address - Country:US
Mailing Address - Phone:423-756-7134
Mailing Address - Fax:423-763-4571
Practice Address - Street 1:7380 VOLKSWAGEN DR
Practice Address - Street 2:SUITE 130
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37416-1755
Practice Address - Country:US
Practice Address - Phone:423-756-7134
Practice Address - Fax:423-763-4571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-04
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15654207XS0106X
TN267872086S0105X, 2086S0122X
TN287962086S0105X, 2086S0122X
TN365022086S0105X, 2086S0122X
TN181702086S0122X
TN387822086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNCL7313OtherRAILROAD MEDICARE
TN2006636OtherBLUE CROSS BLUE SHIELD
TN3378706Medicare PIN
TNCL7313OtherRAILROAD MEDICARE