Provider Demographics
NPI:1407139769
Name:VAIL PLASTIC & COSMETIC SURGERY CENTER
Entity Type:Organization
Organization Name:VAIL PLASTIC & COSMETIC SURGERY CENTER
Other - Org Name:MANGAT PLASTIC SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVINDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:MANGAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-766-3223
Mailing Address - Street 1:0056 EDWARDS VILLAGE BLVD
Mailing Address - Street 2:SUITE #6
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632
Mailing Address - Country:US
Mailing Address - Phone:970-766-3223
Mailing Address - Fax:970-766-3225
Practice Address - Street 1:0056 EDWARDS VILLAGE BLVD
Practice Address - Street 2:SUITE #6
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632
Practice Address - Country:US
Practice Address - Phone:970-766-3223
Practice Address - Fax:970-766-3225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical