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EAST TEXAS PLASTIC SURGERY LLP NPI 1215152251


NPI Information

NPI: 1215152251
Provider Name: EAST TEXAS PLASTIC SURGERY LLP
Classification: Surgery - 2086S0122X
Entity Type: Organization

Specialization: Plastic and Reconstructive Surgery

CLIA Number: 45D1071479

Address:
703 E MARSHALL AVE STE 4008
LONGVIEW, TX
ZIP 75601
Phone: (903) 753-2276
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EAST TEXAS PLASTIC SURGERY LLP is a plastic and reconstructive surgery surgery in Longview, TX. The provider is a surgeon who specializes in plastic and reconstructive surgery. EAST TEXAS PLASTIC SURGERY LLP NPI is 1215152251. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

703 E MARSHALL AVE STE 4008
LONGVIEW, TX
ZIP 75601-622
Phone: (903) 753-2276
Fax: (903) 753-7420

The provider's authorized official is Gary R Jacobs .
The authorized official title is President And Co Owner and has the following contact phone number (903) 753-2276.

The CLIA number assigned to this NPI record is 45D1071479 - home health agency with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/16/2007 and was last updated on 7/18/2016.


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
12086S0122XSurgeryPlastic and Reconstructive SurgeryE4427TEXASYes

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
1C17373MEDICARE UPINTEXAS
286Y711MEDICARE ID-TYPE UNSPECIFIEDTEXAS
3110309502MEDICAIDTEXAS

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

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