Provider Demographics
NPI:1073729604
Name:PLASTIC SURGERY CONCEPTS, PC
Entity Type:Organization
Organization Name:PLASTIC SURGERY CONCEPTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:V
Authorized Official - Last Name:OLIVIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-270-9680
Mailing Address - Street 1:13131 TESSON FERRY RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3887
Mailing Address - Country:US
Mailing Address - Phone:314-270-9680
Mailing Address - Fax:314-270-9681
Practice Address - Street 1:13131 TESSON FERRY RD
Practice Address - Street 2:SUITE 215
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3887
Practice Address - Country:US
Practice Address - Phone:314-270-9680
Practice Address - Fax:314-270-9681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2022-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010048552086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000014849Medicare PIN