Provider Demographics
NPI:1235466236
Name:AESTHETIC PLASTIC SURGERY CENTER, PC
Entity Type:Organization
Organization Name:AESTHETIC PLASTIC SURGERY CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-542-7300
Mailing Address - Street 1:900 N ORANGE ST STE 106
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-2951
Mailing Address - Country:US
Mailing Address - Phone:406-542-7300
Mailing Address - Fax:406-542-0003
Practice Address - Street 1:900 N ORANGE ST STE 106
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-2951
Practice Address - Country:US
Practice Address - Phone:406-542-7300
Practice Address - Fax:406-542-0003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4244174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000080145Medicare UPIN