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General NPI Number Information
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NPI Number | 1336238591
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Entity Type | Organization
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Legal Business Name | CHATHAM FACIAL PLASTIC SURGERY LLC
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 10/24/2011
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Provider Practice Location Address
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Address Line | 1919 STATE STREET SUITE 144
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City | NEW ALBANY
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State | IN
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Zip | 47150
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Country | US
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Telephone | 812-945-3223
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Fax |
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Provider Business Mailing Address
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Address Line | 1919 STATE ST SUITE 144
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City | NEW ALBANY
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State | IN
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Zip | 47150-4929
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Country | US
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Telephone | 812-945-3223
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. FAYTH BREEDING
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Credential |
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Telephone | 812-945-3223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | 23772
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | 01034016
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | 23772
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | 01034016
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License Number State | IN
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