PLASTIC SURGERY CENTER OF ST JOSEPH INC NPI 1508862996

NPI Information

NPI: 1508862996
Provider Name: PLASTIC SURGERY CENTER OF ST JOSEPH, INC
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 26D1019232

Address:
2111 N WOODBINE RD
SAINT JOSEPH, MO
ZIP 64506
Phone: (816) 364-6416
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PLASTIC SURGERY CENTER OF ST JOSEPH, INC is an ambulatory surgical clinic center in Saint Joseph, MO. PLASTIC SURGERY CENTER OF ST JOSEPH, INC NPI is 1508862996. The provider is registered as an organization entity type.

The provider's business location address is:

2111 N WOODBINE RD
SAINT JOSEPH, MO
ZIP 64506-440
Phone: (816) 364-6416
Fax: (816) 364-5320

The provider's authorized official is Michael D De Priest .
The authorized official title is Medical Director and has the following contact phone number (816) 364-6446.

The CLIA number assigned to this NPI record is 26D1019232 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/22/2005 and was last updated on 12/31/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical	136-0	MISSOURI	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	509336905	MEDICAID	MISSOURI
2	136-0	OTHER	MISSOURI	STATE LICENSE NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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