Provider Demographics
NPI:1871119107
Name:REGIONAL PLASTIC SURGERY CENTER PA
Entity type:Organization
Organization Name:REGIONAL PLASTIC SURGERY CENTER PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENTON
Authorized Official - Middle Name:
Authorized Official - Last Name:WATUMULL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-893-6311
Mailing Address - Street 1:1111 SARA SWAMY DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-1779
Mailing Address - Country:US
Mailing Address - Phone:903-893-6311
Mailing Address - Fax:
Practice Address - Street 1:1111 SARA SWAMY DR
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-1779
Practice Address - Country:US
Practice Address - Phone:903-893-6311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGIONAL PLASTIC SURGERY CENTER PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-23
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Single Specialty