Provider Demographics
NPI:1912046210
Name:CENTER FOR AESTHETICS PC
Entity Type:Organization
Organization Name:CENTER FOR AESTHETICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:DURBORAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-529-8232
Mailing Address - Street 1:2375 E SUNNYSIDE ROAD
Mailing Address - Street 2:SUITE G
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404
Mailing Address - Country:US
Mailing Address - Phone:208-529-8232
Mailing Address - Fax:866-499-9979
Practice Address - Street 1:2375 E SUNNYSIDE ROAD
Practice Address - Street 2:SUITE G
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404
Practice Address - Country:US
Practice Address - Phone:208-529-8232
Practice Address - Fax:866-499-9979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDBLUE CROSSOtherDV336
IDBLUE CROSSOtherDV336