Provider Demographics
NPI:1841486313
Name:THE PLASTIC SURGERY CLINIC PA
Entity type:Organization
Organization Name:THE PLASTIC SURGERY CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-776-7500
Mailing Address - Street 1:1419 WESTPORT LANDING PL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2906
Mailing Address - Country:US
Mailing Address - Phone:785-776-7500
Mailing Address - Fax:785-770-8558
Practice Address - Street 1:1419 WESTPORT LANDING PL
Practice Address - Street 2:SUITE 101
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2906
Practice Address - Country:US
Practice Address - Phone:785-776-7500
Practice Address - Fax:785-770-8558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-230132086S0105X
KS04-28013208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110967OtherMEDICARE
KS100396860AMedicaid