Provider Demographics
NPI:1669538971
Name:SOUTHLAND PLASTIC SURGERY
Entity type:Organization
Organization Name:SOUTHLAND PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:T
Authorized Official - Last Name:FALLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-735-3116
Mailing Address - Street 1:PO BOX 1632
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28093-1632
Mailing Address - Country:US
Mailing Address - Phone:704-735-3116
Mailing Address - Fax:704-735-5713
Practice Address - Street 1:501 NORTH ASPEN ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-2105
Practice Address - Country:US
Practice Address - Phone:704-735-3116
Practice Address - Fax:704-735-5713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251342086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8931098Medicaid
NC2163912BMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE