Provider Demographics
NPI:1689700940
Name:ASSOCIATES IN PLASTIC SURGERY, PLLC
Entity Type:Organization
Organization Name:ASSOCIATES IN PLASTIC SURGERY, PLLC
Other - Org Name:DRS WEETER, WHITT & NOEL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEETER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-895-5466
Mailing Address - Street 1:4001 KRESGE WAY
Mailing Address - Street 2:STE 220
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4640
Mailing Address - Country:US
Mailing Address - Phone:502-895-5466
Mailing Address - Fax:502-896-2137
Practice Address - Street 1:4001 KRESGE WAY
Practice Address - Street 2:STE 220
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4640
Practice Address - Country:US
Practice Address - Phone:502-895-5466
Practice Address - Fax:502-896-2137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY163182086S0122X
KY206422086S0122X
246972086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000044025OtherANTHEM
000000044024OtherANTHEM
000000044026OtherANTHEM
C72306Medicare UPIN
D92457Medicare UPIN
1262403Medicare ID - Type Unspecified
000000044026OtherANTHEM
000000044025OtherANTHEM
1232404Medicare ID - Type Unspecified