Provider Demographics
NPI:1093939894
Name:MOUNTAIN BROOK PLASTIC SURGERY AND LASER CENTER
Entity Type:Organization
Organization Name:MOUNTAIN BROOK PLASTIC SURGERY AND LASER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-871-4440
Mailing Address - Street 1:2850 CAHABA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2346
Mailing Address - Country:US
Mailing Address - Phone:205-871-4440
Mailing Address - Fax:205-871-7776
Practice Address - Street 1:2850 CAHABA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35223-2346
Practice Address - Country:US
Practice Address - Phone:205-871-4440
Practice Address - Fax:205-871-7776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL167302086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1310014OtherUNITED HEALTH CARE
AL1310014OtherUNITED HEALTH CARE
ALC46695Medicare UPIN