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General NPI Number Information
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NPI Number | 1225283385
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Entity Type | Organization
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Legal Business Name | PLASTIC SURGERY CONCEPTS
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Dates
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Enumeration Date | 11/17/2008
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Last Update Date | 11/17/2008
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Provider Practice Location Address
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Address Line | 505 COUCH AVE SUITE 360
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City | KIRKWOOD
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State | MO
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Zip | 63122-5568
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Country | US
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Telephone | 314-821-8855
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Fax | 314-965-1296
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Provider Business Mailing Address
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Address Line | 11709 OLD BALLAS RD SUITE 201
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City | CREVE COEUR
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State | MO
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Zip | 63141-7029
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Country | US
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Telephone | 314-997-8828
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Fax | 314-432-5105
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS V. OLIVIER
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Credential | MD
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Telephone | 314-997-8828
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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 | 2001004855
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License Number State | MO
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