Provider Demographics
NPI:1316014681
Name:PLASTIC SURGERY OF TUSCALOOSA INC
Entity type:Organization
Organization Name:PLASTIC SURGERY OF TUSCALOOSA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE
Authorized Official - Prefix:
Authorized Official - First Name:MARQUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-349-0049
Mailing Address - Street 1:1847 COMMONS NORTH DR STE A
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-3700
Mailing Address - Country:US
Mailing Address - Phone:205-349-0049
Mailing Address - Fax:659-734-2003
Practice Address - Street 1:1847 COMMONS NORTH DR STE A
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-3700
Practice Address - Country:US
Practice Address - Phone:205-349-0049
Practice Address - Fax:659-734-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529900080Medicaid
ALI383Medicare PIN