Provider Demographics
NPI:1578734760
Name:ADVANCED BREAST & COSMETIC SURGERY CENTER
Entity Type:Organization
Organization Name:ADVANCED BREAST & COSMETIC SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:RIGANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-293-3800
Mailing Address - Street 1:500 LINCOLN PARK BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-3492
Mailing Address - Country:US
Mailing Address - Phone:937-293-3800
Mailing Address - Fax:937-293-9549
Practice Address - Street 1:500 LINCOLN PARK BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-3492
Practice Address - Country:US
Practice Address - Phone:937-293-3800
Practice Address - Fax:937-293-9549
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED BREAST & COSMETIC SURGERY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6800546OtherUNITED HEALTHCARE