Provider Demographics
NPI:1457689770
Name:CENTER FOR PLASTIC SURGERY, PA
Entity type:Organization
Organization Name:CENTER FOR PLASTIC SURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:TELLIN
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:785-234-9000
Mailing Address - Street 1:631 SW HORNE ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1694
Mailing Address - Country:US
Mailing Address - Phone:785-234-9000
Mailing Address - Fax:785-234-9119
Practice Address - Street 1:631 SW HORNE ST
Practice Address - Street 2:SUITE 400
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1694
Practice Address - Country:US
Practice Address - Phone:785-234-9000
Practice Address - Fax:785-234-9119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty