Provider Demographics
NPI:1083737027
Name:PLASTIC SURGERY GROUP INC
Entity Type:Organization
Organization Name:PLASTIC SURGERY GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WETHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-349-5512
Mailing Address - Street 1:4030 SMITH ROAD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-1969
Mailing Address - Country:US
Mailing Address - Phone:513-791-4440
Mailing Address - Fax:513-985-6615
Practice Address - Street 1:4030 SMITH ROAD
Practice Address - Street 2:SUITE 350
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-1969
Practice Address - Country:US
Practice Address - Phone:513-791-4440
Practice Address - Fax:513-985-6615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0167877Medicaid
KYCB9040Medicare PIN
OH9279591Medicare PIN
OH0167877Medicaid
KY3282Medicare PIN