Provider Demographics
NPI:1841306974
Name:THE PLASTIC SURGERY GROUP SC
Entity type:Organization
Organization Name:THE PLASTIC SURGERY GROUP SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:E
Authorized Official - Last Name:KINNEY-HORVAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-847-0444
Mailing Address - Street 1:425 PINE RIDGE BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401
Mailing Address - Country:US
Mailing Address - Phone:715-847-0444
Mailing Address - Fax:715-847-0445
Practice Address - Street 1:425 PINE RIDGE BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401
Practice Address - Country:US
Practice Address - Phone:715-847-0444
Practice Address - Fax:715-847-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty