Provider Demographics
NPI:1972772309
Name:AESTHETIC SURGERY ASSOCIATES LLP
Entity Type:Organization
Organization Name:AESTHETIC SURGERY ASSOCIATES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-626-5106
Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76540-0938
Mailing Address - Country:US
Mailing Address - Phone:254-634-6999
Mailing Address - Fax:254-200-4099
Practice Address - Street 1:2301 S CLEAR CREEK RD
Practice Address - Street 2:SUITE 106
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4198
Practice Address - Country:US
Practice Address - Phone:254-526-5106
Practice Address - Fax:254-526-7853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155219201Medicaid
TX0040JFDOtherBCBS OF TEXAS
TX00132UMedicare PIN