Provider Demographics
NPI:1245662998
Name:PRECISION PLASTIC SURGERY, PA COLUMBUS
Entity type:Organization
Organization Name:PRECISION PLASTIC SURGERY, PA COLUMBUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-641-1491
Mailing Address - Street 1:2995 REIDVILLE RD
Mailing Address - Street 2:STE 150
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-5668
Mailing Address - Country:US
Mailing Address - Phone:864-641-1491
Mailing Address - Fax:
Practice Address - Street 1:54 HOSPITAL DR
Practice Address - Street 2:STE 3B
Practice Address - City:COLUMBUS
Practice Address - State:NC
Practice Address - Zip Code:28722-8516
Practice Address - Country:US
Practice Address - Phone:864-641-1491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRECISION PLASTIC SURGERY, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP6202Medicaid
SCT49356Medicaid
SCG90271-2042Medicare UPIN
SCGP6202Medicaid