Provider Demographics
NPI:1780897272
Name:HILTON HEAD ISLAND PLASTIC SURGERY, LLC
Entity type:Organization
Organization Name:HILTON HEAD ISLAND PLASTIC SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ABEL
Authorized Official - Last Name:LAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-681-4088
Mailing Address - Street 1:35 BILL FRIES DR
Mailing Address - Street 2:ISLAND MEDICAL PLAZA, BLDG E
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2730
Mailing Address - Country:US
Mailing Address - Phone:843-681-4088
Mailing Address - Fax:843-689-3742
Practice Address - Street 1:35 BILL FRIES DR
Practice Address - Street 2:ISLAND MEDICAL PLAZA, BLDG E
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2730
Practice Address - Country:US
Practice Address - Phone:843-681-4088
Practice Address - Fax:843-689-3742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC86952086S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC086953Medicaid
SC086953Medicaid
SC5454Medicare PIN