Provider Demographics
NPI:1326252479
Name:THE CENTER FOR PLASTIC & COSMETIC SURGERY. LLC
Entity Type:Organization
Organization Name:THE CENTER FOR PLASTIC & COSMETIC SURGERY. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:KLUSKA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:724-836-0400
Mailing Address - Street 1:530 SOUTH ST
Mailing Address - Street 2:SUITE G-10
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2775
Mailing Address - Country:US
Mailing Address - Phone:724-836-0400
Mailing Address - Fax:724-836-6422
Practice Address - Street 1:530 SOUTH ST
Practice Address - Street 2:SUITE G-10
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2775
Practice Address - Country:US
Practice Address - Phone:724-836-0400
Practice Address - Fax:724-836-6422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA077614Medicare ID - Type Unspecified