Provider Demographics
NPI:1750317020
Name:PLASTIC & HAND SURGERY ASSOCIATES, S.C.
Entity Type:Organization
Organization Name:PLASTIC & HAND SURGERY ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMORN
Authorized Official - Middle Name:
Authorized Official - Last Name:SALYAPONGSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-235-8500
Mailing Address - Street 1:2900 FRANK SCOTT PKWY W
Mailing Address - Street 2:#970
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-5000
Mailing Address - Country:US
Mailing Address - Phone:618-235-8500
Mailing Address - Fax:618-235-2929
Practice Address - Street 1:2900 FRANK SCOTT PKWY W
Practice Address - Street 2:#970
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-5000
Practice Address - Country:US
Practice Address - Phone:618-235-8500
Practice Address - Fax:618-235-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL521750Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER