Provider Demographics
NPI:1194745620
Name:FACIAL SURGERY GROUP PC
Entity type:Organization
Organization Name:FACIAL SURGERY GROUP PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOUANN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-561-1115
Mailing Address - Street 1:PO BOX 802752
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-0001
Mailing Address - Country:US
Mailing Address - Phone:816-561-1115
Mailing Address - Fax:816-753-4493
Practice Address - Street 1:4700 BELLEVIEW
Practice Address - Street 2:STE L 10
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-1360
Practice Address - Country:US
Practice Address - Phone:816-561-1115
Practice Address - Fax:816-931-7912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE0152161223S0112X
MODE0159051223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO27056013OtherBCBS OF KCMO
MOK520000Medicare ID - Type Unspecified