Provider Demographics
NPI:1477573228
Name:GREENVILLE PLASTIC SURGERY ASSOCIATES, LTD
Entity Type:Organization
Organization Name:GREENVILLE PLASTIC SURGERY ASSOCIATES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-588-2330
Mailing Address - Street 1:53 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-1809
Mailing Address - Country:US
Mailing Address - Phone:724-588-2330
Mailing Address - Fax:724-588-2335
Practice Address - Street 1:53 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-1809
Practice Address - Country:US
Practice Address - Phone:724-588-2330
Practice Address - Fax:724-588-2335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042232E2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0713544Medicaid
OH0719860Medicaid
OH0719860Medicaid
D71683Medicare UPIN
PA0549800001Medicare NSC
OH9255121Medicare PIN