Provider Demographics
NPI:1962504803
Name:HIGHLAND PARK PLASTIC SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:HIGHLAND PARK PLASTIC SURGERY CENTER, LLC
Other - Org Name:HIGHLAND PARK PLASTIC SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:TOLEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:214-363-4444
Mailing Address - Street 1:6110 SHERRY LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6301
Mailing Address - Country:US
Mailing Address - Phone:214-363-4444
Mailing Address - Fax:214-363-8064
Practice Address - Street 1:6110 SHERRY LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6301
Practice Address - Country:US
Practice Address - Phone:214-363-4444
Practice Address - Fax:214-363-8064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000351261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH1395Medicare ID - Type Unspecified