Provider Demographics
NPI:1134668643
Name:PLASTIC SURGERY CENTER
Entity Type:Organization
Organization Name:PLASTIC SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:PAYEA
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:303-232-0310
Mailing Address - Street 1:8805 W 14TH AVE
Mailing Address - Street 2:SUITE 316
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-4848
Mailing Address - Country:US
Mailing Address - Phone:303-232-0310
Mailing Address - Fax:303-232-0312
Practice Address - Street 1:8805 W 14TH AVE
Practice Address - Street 2:SUITE 316
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-4848
Practice Address - Country:US
Practice Address - Phone:303-232-0310
Practice Address - Fax:303-232-0312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0022517208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01225176Medicaid
CO01225176Medicaid