Provider Demographics
NPI:1023721537
Name:ALTA BELLA PLASTIC SURGERY PLLC
Entity type:Organization
Organization Name:ALTA BELLA PLASTIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:SCHEEFER
Authorized Official - Last Name:VAN BOERUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-613-1626
Mailing Address - Street 1:370 E 9TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-3185
Mailing Address - Country:US
Mailing Address - Phone:801-613-1626
Mailing Address - Fax:
Practice Address - Street 1:370 E 9TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-3185
Practice Address - Country:US
Practice Address - Phone:801-613-1626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty