Provider Demographics
NPI:1790961761
Name:QUINTERO PLASTIC SURGERY AND COSMETIC CENTER PLLC
Entity Type:Organization
Organization Name:QUINTERO PLASTIC SURGERY AND COSMETIC CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GRETA
Authorized Official - Middle Name:J
Authorized Official - Last Name:THRASHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-895-1900
Mailing Address - Street 1:PO BOX 7342
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40257-0342
Mailing Address - Country:US
Mailing Address - Phone:502-895-1900
Mailing Address - Fax:502-893-2937
Practice Address - Street 1:127 FAIRFAX AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4905
Practice Address - Country:US
Practice Address - Phone:502-895-1900
Practice Address - Fax:502-893-2937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39660208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty