Provider Demographics
NPI:1578718474
Name:PLASTIC SURGERY CONCEPTS
Entity Type:Organization
Organization Name:PLASTIC SURGERY CONCEPTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:V
Authorized Official - Last Name:OLIVIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-997-8828
Mailing Address - Street 1:11709 OLD BALLAS RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7029
Mailing Address - Country:US
Mailing Address - Phone:314-997-8828
Mailing Address - Fax:314-432-5105
Practice Address - Street 1:1170B E GANNON DR
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2612
Practice Address - Country:US
Practice Address - Phone:314-937-3178
Practice Address - Fax:314-937-3690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001004855208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOC94463Medicare UPIN