Provider Demographics
NPI:1265674253
Name:PLASTIC SURGERY CENTER OF THE CAROLINAS
Entity Type:Organization
Organization Name:PLASTIC SURGERY CENTER OF THE CAROLINAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-573-6500
Mailing Address - Street 1:391 SERPENTINE DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3096
Mailing Address - Country:US
Mailing Address - Phone:864-573-6500
Mailing Address - Fax:864-583-1553
Practice Address - Street 1:391 SERPENTINE DR STE 300
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3080
Practice Address - Country:US
Practice Address - Phone:864-573-6500
Practice Address - Fax:864-583-1553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty