Provider Demographics
NPI:1184856353
Name:COSMETIC CENTER OF EVANSVILLE
Entity Type:Organization
Organization Name:COSMETIC CENTER OF EVANSVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:HASTETTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-476-6161
Mailing Address - Street 1:7145 E VIRGINIA ST
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-9144
Mailing Address - Country:US
Mailing Address - Phone:812-476-6161
Mailing Address - Fax:
Practice Address - Street 1:7145 E VIRGINIA ST
Practice Address - Street 2:SUITE 2000
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-9144
Practice Address - Country:US
Practice Address - Phone:812-476-6161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty