Provider Demographics
NPI:1578732848
Name:RENEW COSMETIC AND RECONSTRUCTIVE SURGERY, PC
Entity Type:Organization
Organization Name:RENEW COSMETIC AND RECONSTRUCTIVE SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:712-264-6437
Mailing Address - Street 1:1200 1ST AVE E
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-4330
Mailing Address - Country:US
Mailing Address - Phone:712-264-6198
Mailing Address - Fax:712-264-6462
Practice Address - Street 1:116 E 11TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-4364
Practice Address - Country:US
Practice Address - Phone:877-264-8394
Practice Address - Fax:712-264-8391
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPENCER MUNICIPAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-21
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty