Provider Demographics
NPI:1437571668
Name:PREMIER PLASTIC SURGERY CENTER
Entity Type:Organization
Organization Name:PREMIER PLASTIC SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:W
Authorized Official - Last Name:VAN HOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-930-9990
Mailing Address - Street 1:2228 CAHABA VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2665
Mailing Address - Country:US
Mailing Address - Phone:205-930-9990
Mailing Address - Fax:205-380-9995
Practice Address - Street 1:2228 CAHABA VALLEY DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-2665
Practice Address - Country:US
Practice Address - Phone:205-930-9990
Practice Address - Fax:205-380-9995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12633261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical