Provider Demographics
NPI:1356302723
Name:THE PLASTIC SURGERY GROUP, P.C.
Entity Type:Organization
Organization Name:THE PLASTIC SURGERY GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-756-7134
Mailing Address - Street 1:901 RIVERFRONT PARKWAY
Mailing Address - Street 2:STE 100
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-2102
Mailing Address - Country:US
Mailing Address - Phone:423-756-7134
Mailing Address - Fax:423-763-4571
Practice Address - Street 1:901 RIVERFRONT PARKWAY
Practice Address - Street 2:STE 100
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-2136
Practice Address - Country:US
Practice Address - Phone:423-756-7134
Practice Address - Fax:423-763-4571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNCL7313OtherRAILROAD MEDICARE
TN2006636OtherBLUE CROSS BLUE SHIELD
TN3378706Medicare PIN
TN2006636OtherBLUE CROSS BLUE SHIELD