Provider Demographics
NPI:1609976653
Name:LADIES PLASTIC SURGERY CENTER PA
Entity type:Organization
Organization Name:LADIES PLASTIC SURGERY CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-241-5083
Mailing Address - Street 1:12801 MIDWAY RD
Mailing Address - Street 2:SUITE 217
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-6813
Mailing Address - Country:US
Mailing Address - Phone:214-361-5070
Mailing Address - Fax:972-241-5075
Practice Address - Street 1:12801 MIDWAY RD
Practice Address - Street 2:SUITE 217
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-6813
Practice Address - Country:US
Practice Address - Phone:214-361-5070
Practice Address - Fax:972-241-5075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5194174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty