Healthcare Provider Details

I. General information

NPI: 1083737027
Provider Name (Legal Business Name): PLASTIC SURGERY GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 SMITH ROAD SUITE 350
CINCINNATI OH
45209-1969
US

IV. Provider business mailing address

4030 SMITH ROAD SUITE 350
CINCINNATI OH
45209-1969
US

V. Phone/Fax

Practice location:
  • Phone: 513-791-4440
  • Fax: 513-985-6615
Mailing address:
  • Phone: 513-791-4440
  • Fax: 513-985-6615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. STEPHANIE WETHINGTON
Title or Position: PRACTICE ADMINISTATOR
Credential:
Phone: 513-349-5512