Healthcare Provider Details

I. General information

NPI: 1205018199
Provider Name (Legal Business Name): FACIAL PLASTIC & COSMETIC SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 02/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10448 OLD OLIVE STREET RD SUITE 200
SAINT LOUIS MO
63141-5927
US

IV. Provider business mailing address

10448 OLD OLIVE STREET RD SUITE 200
SAINT LOUIS MO
63141-5927
US

V. Phone/Fax

Practice location:
  • Phone: 314-743-4000
  • Fax: 314-743-8055
Mailing address:
  • Phone: 314-743-4000
  • Fax: 314-743-8055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: FRANK SIMO
Title or Position: PRESIDENT, OWNER
Credential: MD
Phone: 314-743-4000