Provider Demographics
NPI:1134965262
Name:PLASTIC SURGERY ASSOCIATES PA
Entity type:Organization
Organization Name:PLASTIC SURGERY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-200-8580
Mailing Address - Street 1:1250 8TH AVE STE 265
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4125
Mailing Address - Country:US
Mailing Address - Phone:682-200-8580
Mailing Address - Fax:682-200-8581
Practice Address - Street 1:915 HIGHLAND BLVD STE 4500
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6902
Practice Address - Country:US
Practice Address - Phone:682-200-8580
Practice Address - Fax:682-200-8581
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLASTIC SURGERY ASSOCIATES PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty