Provider Demographics
NPI:1154200624
Name:PREMIER AESTHETIC SURGICENTER LLC
Entity type:Organization
Organization Name:PREMIER AESTHETIC SURGICENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-274-7434
Mailing Address - Street 1:670 N MACARTHUR BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2732
Mailing Address - Country:US
Mailing Address - Phone:650-274-7434
Mailing Address - Fax:
Practice Address - Street 1:670 N MACARTHUR BLVD STE 120
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-2732
Practice Address - Country:US
Practice Address - Phone:650-274-7434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Multi-Specialty