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General NPI Number Information
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NPI Number | 1275808024
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Entity Type | Organization
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Legal Business Name | GENESIS PLASTIC SURGERY PC
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 03/13/2012
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Provider Practice Location Address
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Address Line | 100 WESTWOODS DR.
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City | LIBERTY
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State | MO
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Zip | 64068-1181
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Country | US
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Telephone | 816-781-3371
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Fax |
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Provider Business Mailing Address
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Address Line | 100 WESTWOODS DR.
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City | LIBERTY
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State | MO
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Zip | 64068-1181
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Country | US
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Telephone | 816-781-3371
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FREDERICK E. THOMPSON
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Credential | M.D.
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Telephone | 816-781-3371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | R8A10
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License Number State | MO
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