Provider Demographics
NPI:1114225703
Name:NESS PLASTIC SURGERY, LLC
Entity Type:Organization
Organization Name:NESS PLASTIC SURGERY, LLC
Other - Org Name:JOHN A NESS MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:NESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-559-4500
Mailing Address - Street 1:1952 LUCILLE LN
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-0434
Mailing Address - Country:US
Mailing Address - Phone:763-559-4500
Mailing Address - Fax:763-559-1733
Practice Address - Street 1:2805 CAMPUS DR
Practice Address - Street 2:SUITE 485
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2676
Practice Address - Country:US
Practice Address - Phone:763-559-4500
Practice Address - Fax:763-559-1733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN36379174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MND16752Medicare UPIN
MND80188Medicare UPIN
MND75422Medicare UPIN
MND76688Medicare UPIN