Provider Demographics
NPI:1497821417
Name:ASHEVILLE PLASTIC SURGERY PA
Entity Type:Organization
Organization Name:ASHEVILLE PLASTIC SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-254-1234
Mailing Address - Street 1:5 LIVINGSTON STREET
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801
Mailing Address - Country:US
Mailing Address - Phone:828-254-1234
Mailing Address - Fax:828-254-2423
Practice Address - Street 1:5 LIVINGSTON STREET
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801
Practice Address - Country:US
Practice Address - Phone:828-254-1234
Practice Address - Fax:828-254-2423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20619174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901413Medicaid
NC01413OtherBCBS
NC01413OtherBCBS
NC0751Medicare ID - Type Unspecified