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General NPI Number Information
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NPI Number | 1184856353
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Entity Type | Organization
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Legal Business Name | COSMETIC CENTER OF EVANSVILLE
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Dates
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Enumeration Date | 08/20/2009
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Last Update Date | 08/20/2009
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Provider Practice Location Address
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Address Line | 7145 E VIRGINIA ST SUITE 2000
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City | EVANSVILLE
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State | IN
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Zip | 47715-9144
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Country | US
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Telephone | 812-476-6161
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Fax |
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Provider Business Mailing Address
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Address Line | 7145 E VIRGINIA ST SUITE 2000
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City | EVANSVILLE
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State | IN
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Zip | 47715-9144
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Country | US
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Telephone | 812-476-6161
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS S HASTETTER
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Credential | M.D.
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Telephone | 812-476-6161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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