Provider Demographics
NPI:1356672976
Name:MAGUIRE PLASTIC SURGERY, LLC
Entity Type:Organization
Organization Name:MAGUIRE PLASTIC SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:MAGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-572-3454
Mailing Address - Street 1:102 THOMAS RD
Mailing Address - Street 2:SUITE 119
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7366
Mailing Address - Country:US
Mailing Address - Phone:318-338-3560
Mailing Address - Fax:318-338-3564
Practice Address - Street 1:102 THOMAS RD
Practice Address - Street 2:SUITE 119
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7366
Practice Address - Country:US
Practice Address - Phone:318-338-3560
Practice Address - Fax:318-338-3564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-21
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0231492086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1494950Medicaid
LA1494950Medicaid