Provider Demographics
NPI:1851939953
Name:NORTHWEST COSMETIC SURGERY HOLDINGS LLC
Entity Type:Organization
Organization Name:NORTHWEST COSMETIC SURGERY HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-388-1022
Mailing Address - Street 1:777 SW MILL VIEW WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1140
Mailing Address - Country:US
Mailing Address - Phone:541-388-1022
Mailing Address - Fax:541-322-7002
Practice Address - Street 1:777 SW MILL VIEW WAY STE 100
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1140
Practice Address - Country:US
Practice Address - Phone:541-388-1022
Practice Address - Fax:541-322-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty