Provider Demographics
NPI:1417372749
Name:PLASTIC SURGERY ASSOCIATES OF MONTGOMERY
Entity Type:Organization
Organization Name:PLASTIC SURGERY ASSOCIATES OF MONTGOMERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:BENTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-284-2800
Mailing Address - Street 1:6727 TAYLOR CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7708
Mailing Address - Country:US
Mailing Address - Phone:334-284-2800
Mailing Address - Fax:334-284-0438
Practice Address - Street 1:6727 TAYLOR CT
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7708
Practice Address - Country:US
Practice Address - Phone:334-284-2800
Practice Address - Fax:334-284-0438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12601261QA1903X, 261QM2500X
AL12411261QA1903X, 261QM2500X
AL14727261QA1903X, 261QM2500X
AL24023261QA1903X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty