Provider Demographics
NPI:1639320864
Name:MISSISSIPPI PREMIER PLASTIC SURGERY, PLLC
Entity Type:Organization
Organization Name:MISSISSIPPI PREMIER PLASTIC SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BYERS
Authorized Official - Suffix:
Authorized Official - Credentials:CMPE
Authorized Official - Phone:601-981-2525
Mailing Address - Street 1:160 FOUNTAINS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-4643
Mailing Address - Country:US
Mailing Address - Phone:601-981-2525
Mailing Address - Fax:601-981-3152
Practice Address - Street 1:160 FOUNTAINS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-4643
Practice Address - Country:US
Practice Address - Phone:601-981-2525
Practice Address - Fax:601-981-3152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Single Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Single Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Single Specialty