Provider Demographics
NPI:1821568304
Name:PLASTIC SURGERY ASSOCIATES PA
Entity Type:Organization
Organization Name:PLASTIC SURGERY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-200-8580
Mailing Address - Street 1:8601 CANTERA WAY
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-1133
Mailing Address - Country:US
Mailing Address - Phone:512-763-4545
Mailing Address - Fax:512-763-4546
Practice Address - Street 1:10900 HEFNER POINTE DR STE 505
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-5006
Practice Address - Country:US
Practice Address - Phone:405-246-0391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLASTIC SURGERY ASSOCIATES PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-28
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty