Provider Demographics
NPI:1477638864
Name:PLASTIC SURGERY INSTITUTE, PC
Entity Type:Organization
Organization Name:PLASTIC SURGERY INSTITUTE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-293-7408
Mailing Address - Street 1:3280 20TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-5917
Mailing Address - Country:US
Mailing Address - Phone:701-293-7408
Mailing Address - Fax:701-235-2099
Practice Address - Street 1:3280 20TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-5917
Practice Address - Country:US
Practice Address - Phone:701-293-7408
Practice Address - Fax:701-235-2099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND11131Medicaid
ND1163001OtherBS N DAKOTA
MN834693300Medicaid
MN03T03ABOtherBS MINNESOTA
ND11131Medicaid