Provider Demographics
NPI:1053506980
Name:CENTER FOR PLASTIC SURGERY
Entity Type:Organization
Organization Name:CENTER FOR PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:C
Authorized Official - Last Name:HAINES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-732-5788
Mailing Address - Street 1:P.O. BOX 11226
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29211-1226
Mailing Address - Country:US
Mailing Address - Phone:803-732-5788
Mailing Address - Fax:803-932-9618
Practice Address - Street 1:7033 SAINT ANDREWS RD
Practice Address - Street 2:SUITE 204
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-1179
Practice Address - Country:US
Practice Address - Phone:803-732-5788
Practice Address - Fax:803-932-9618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13063208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCB91324Medicare UPIN
SC3951Medicare PIN