Provider Demographics
NPI:1407278906
Name:PLASTIC SURGERY ASSISTANTS PA
Entity Type:Organization
Organization Name:PLASTIC SURGERY ASSISTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEC COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMACHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-923-7611
Mailing Address - Street 1:9101 N CENTRAL EXPY
Mailing Address - Street 2:STE 600
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-5927
Mailing Address - Country:US
Mailing Address - Phone:214-540-1420
Mailing Address - Fax:214-540-1423
Practice Address - Street 1:9101 N CENTRAL EXPY
Practice Address - Street 2:STE 600
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5927
Practice Address - Country:US
Practice Address - Phone:214-540-1420
Practice Address - Fax:214-540-1423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty