Provider Demographics
NPI:1275974149
Name:ADVANCED PLASTIC SURGERY INSTITUTE, PLLC
Entity Type:Organization
Organization Name:ADVANCED PLASTIC SURGERY INSTITUTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:R
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-879-0369
Mailing Address - Street 1:1482 E WILLIAMS FIELD RD
Mailing Address - Street 2:B101
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1816
Mailing Address - Country:US
Mailing Address - Phone:480-466-7355
Mailing Address - Fax:480-939-2751
Practice Address - Street 1:1482 E WILLIAMS FIELD RD
Practice Address - Street 2:B101
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1816
Practice Address - Country:US
Practice Address - Phone:480-466-7355
Practice Address - Fax:480-939-2751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-08
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ47493261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty