Provider Demographics
NPI:1811164296
Name:ADVANCED COSMETIC SURGERY CTR WM K MILES MD PA
Entity type:Organization
Organization Name:ADVANCED COSMETIC SURGERY CTR WM K MILES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-336-9131
Mailing Address - Street 1:800 8TH AVENUE
Mailing Address - Street 2:SUITE 404
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2618
Mailing Address - Country:US
Mailing Address - Phone:817-336-9131
Mailing Address - Fax:817-336-9457
Practice Address - Street 1:800 8TH AVENUE
Practice Address - Street 2:SUITE 404
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2618
Practice Address - Country:US
Practice Address - Phone:817-336-9131
Practice Address - Fax:817-336-9457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD2529207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC19375Medicare UPIN