Provider Demographics
NPI:1164481735
Name:ADVANCED COSMETIC SURGERY, P.A.
Entity Type:Organization
Organization Name:ADVANCED COSMETIC SURGERY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-341-2188
Mailing Address - Street 1:11401 NALL AVE
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1674
Mailing Address - Country:US
Mailing Address - Phone:913-341-2188
Mailing Address - Fax:913-341-0030
Practice Address - Street 1:11401 NALL AVE
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1674
Practice Address - Country:US
Practice Address - Phone:913-341-2188
Practice Address - Fax:913-341-0030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0426718174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty