MEDICARE: FACIAL RECONSTRUCTIVE SURGERY ASSOCIATES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	H4243	TX

General Provider Information

NPI Number	:	1528499779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FACIAL RECONSTRUCTIVE SURGERY ASSOCIATES, PLLC

Provider Business Mailing Address
First Line	:	38 GRAND REGENCY CIR
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77382-1608
Country	:	US
Telephone Number	:	281-362-0138
Fax Number	:	281-362-7995

Provider Business Practice Location Address
First Line	:	38 GRAND REGENCY CIR
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77382-1608
Country	:	US
Telephone Number	:	281-362-0138
Fax Number	:	281-362-7995

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. SCOTT ALAN COHEN
Credential	:	M.D.
Telephone Number	:	281-362-0138

Provider Enumeration Date	:	12/12/2013
Last Update Date	:	12/12/2013

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