Provider Demographics
NPI:1437436201
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 1:56 EDWARDS VILLAGE BOULEVARD
Mailing Address - Street 2:#226
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-7804
Mailing Address - Country:US
Mailing Address - Phone:970-766-3223
Mailing Address - Fax:970-766-3225
Practice Address - Street 1:56 EDWARDS VILLAGE BOULEVARD
Practice Address - Street 2:#226
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-7804
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:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2082S0099X
CO33471261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC72099Medicare UPIN