Provider Demographics
NPI:1366441966
Name:ASSOCIATED PLASTIC SURGEONS PA
Entity type:Organization
Organization Name:ASSOCIATED PLASTIC SURGEONS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH LISA
Authorized Official - Middle Name:G
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-451-3722
Mailing Address - Street 1:11501 GRANADA ST
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1454
Mailing Address - Country:US
Mailing Address - Phone:913-451-3722
Mailing Address - Fax:913-451-5000
Practice Address - Street 1:11501 GRANADA ST
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1454
Practice Address - Country:US
Practice Address - Phone:913-451-3722
Practice Address - Fax:913-451-5000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP7309OtherRAILROAD MEDICARE
CP7309OtherRAILROAD MEDICARE