Provider Demographics
NPI:1013997204
Name:BLAIR COUNTY PLASTIC SURGERY INC
Entity Type:Organization
Organization Name:BLAIR COUNTY PLASTIC SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:LOUTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-949-7280
Mailing Address - Street 1:3107 FAIRWAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602
Mailing Address - Country:US
Mailing Address - Phone:814-949-7280
Mailing Address - Fax:814-949-7283
Practice Address - Street 1:3107 FAIRWAY DRIVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602
Practice Address - Country:US
Practice Address - Phone:814-949-7280
Practice Address - Fax:814-949-7283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045155E2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00011873520001Medicaid
PAE83543OtherPREFERRED HEALTH CARE
583543Medicare ID - Type Unspecified
B92675Medicare UPIN