Provider Demographics
NPI:1437386067
Name:THE HUNSTAD KORTESIS CENTER
Entity Type:Organization
Organization Name:THE HUNSTAD KORTESIS CENTER
Other - Org Name:THE HUNSTAD CENTER FOR COSMETIC PLASTIC SURGERY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-659-9000
Mailing Address - Street 1:11208 STATESVILLE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-7637
Mailing Address - Country:US
Mailing Address - Phone:704-659-9000
Mailing Address - Fax:704-659-9009
Practice Address - Street 1:11208 STATESVILLE RD
Practice Address - Street 2:STE 300
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7637
Practice Address - Country:US
Practice Address - Phone:704-659-9000
Practice Address - Fax:704-659-9009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2086S0122X
NC261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2073764OtherMEDICARE PTAN
NC2073762OtherMEDICARE PTAN
NCNC7927AOtherMEDICARE PTAN
NCNCA260OtherMEDICARE PTAN
NCNCA260OtherMEDICARE PTAN