Provider Demographics
NPI:1831644673
Name:NORTHSTATE PLASTIC SURGERY CENTER
Entity Type:Organization
Organization Name:NORTHSTATE PLASTIC SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-345-5900
Mailing Address - Street 1:PO BOX 8505
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95927-8505
Mailing Address - Country:US
Mailing Address - Phone:530-345-5900
Mailing Address - Fax:530-345-5995
Practice Address - Street 1:1260 EAST AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1021
Practice Address - Country:US
Practice Address - Phone:530-345-5900
Practice Address - Fax:530-345-5995
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHSTATE PLASTIC SURGERY ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical