Provider Demographics
NPI:1366641524
Name:PLASTIC SURGERY ASSOCIATES, L.L.P.
Entity Type:Organization
Organization Name:PLASTIC SURGERY ASSOCIATES, L.L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-764-4600
Mailing Address - Street 1:515 VALLEY VIEW DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6175
Mailing Address - Country:US
Mailing Address - Phone:309-764-4600
Mailing Address - Fax:309-764-4671
Practice Address - Street 1:515 VALLEY VIEW DR STE 201
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6175
Practice Address - Country:US
Practice Address - Phone:309-764-4600
Practice Address - Fax:309-764-4671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL264680Medicare PIN