Provider Demographics
NPI:1346468030
Name:THE PLASTIC SURGERY GROUP
Entity Type:Organization
Organization Name:THE PLASTIC SURGERY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-791-4440
Mailing Address - Street 1:340 THOMAS MORE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-5100
Mailing Address - Country:US
Mailing Address - Phone:859-331-8777
Mailing Address - Fax:859-344-3263
Practice Address - Street 1:340 THOMAS MORE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-5100
Practice Address - Country:US
Practice Address - Phone:859-331-8777
Practice Address - Fax:859-344-3263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0167877Medicaid
CJ2110Medicare ID - Type UnspecifiedMEDICARE RAILROAD
OH0167877Medicaid
OH9279591Medicare ID - Type Unspecified