Provider Demographics
NPI:1245325307
Name:PLASTIC SURGERY SPECIALISTS
Entity type:Organization
Organization Name:PLASTIC SURGERY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYRIC
Authorized Official - Middle Name:B
Authorized Official - Last Name:CROOK
Authorized Official - Suffix:
Authorized Official - Credentials:CMOM
Authorized Official - Phone:205-298-8660
Mailing Address - Street 1:2000 STONEGATE TRL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2246
Mailing Address - Country:US
Mailing Address - Phone:205-298-8660
Mailing Address - Fax:205-298-8664
Practice Address - Street 1:2000 STONEGATE TRL
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-2246
Practice Address - Country:US
Practice Address - Phone:205-298-8660
Practice Address - Fax:205-298-8664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1518910892OtherDR. JACK'S NPI#
AL1891880928OtherSR. OLIVER JR'S NPI#
AL1043305139OtherDR. OLIVER SR'S NPI#
AL1043305139OtherDR. OLIVER SR'S NPI#