Provider Demographics
NPI:1073713160
Name:CENTER FOR PLASTIC SURGERY PSC
Entity Type:Organization
Organization Name:CENTER FOR PLASTIC SURGERY PSC
Other - Org Name:DR. SANDRA BOUZAGLOU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-263-8083
Mailing Address - Street 1:501 DARBY CREEK RD
Mailing Address - Street 2:SUITE 59
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1604
Mailing Address - Country:US
Mailing Address - Phone:859-263-8083
Mailing Address - Fax:859-263-9160
Practice Address - Street 1:501 DARBY CREEK RD
Practice Address - Street 2:SUITE 59
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1604
Practice Address - Country:US
Practice Address - Phone:859-263-8083
Practice Address - Fax:859-263-9160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25984174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty