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General NPI Number Information
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NPI Number | 1417372749
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Entity Type | Organization
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Legal Business Name | PLASTIC SURGERY ASSOCIATES OF MONTGOMERY
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Dates
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Enumeration Date | 02/24/2014
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Last Update Date | 02/24/2014
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Provider Practice Location Address
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Address Line | 6727 TAYLOR CT
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City | MONTGOMERY
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State | AL
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Zip | 36117-7708
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Country | US
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Telephone | 334-284-2800
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Fax | 334-284-0438
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Provider Business Mailing Address
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Address Line | 6727 TAYLOR CT
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City | MONTGOMERY
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State | AL
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Zip | 36117-7708
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Country | US
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Telephone | 334-284-2800
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Fax | 334-284-0438
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Authorized Official
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Title or Position | SURGEON/PRESIDENT
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Name | DR. MICHAEL P BENTLEY
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Credential | M.D.
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Telephone | 334-284-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 12411
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 14727
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 24023
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License Number State | AL
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Taxonomy #4
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 12601
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License Number State | AL
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Taxonomy #5
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 12411
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License Number State | AL
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Taxonomy #6
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 14727
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License Number State | AL
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Taxonomy #7
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 24023
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License Number State | AL
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Taxonomy #8
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 12601
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License Number State | AL
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