Provider Demographics
NPI:1689001067
Name:CLINTON PLASTIC SURGERY, LLC
Entity Type:Organization
Organization Name:CLINTON PLASTIC SURGERY, LLC
Other - Org Name:CLINTON SURGERY SUITE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:CLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-408-9787
Mailing Address - Street 1:7191 CAHABA VALLEY RD
Mailing Address - Street 2:200
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7191 CAHABA VALLEY RD
Practice Address - Street 2:200
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-6402
Practice Address - Country:US
Practice Address - Phone:205-408-9787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-01
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL109392086S0122X, 261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty