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General NPI Number Information
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NPI Number | 1740891274
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Entity Type | Organization
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Legal Business Name | SIGNATURE SURGICAL ARTS AND MEDSPA PLLC
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Dates
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Enumeration Date | 08/10/2020
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 3100 N WELLNESS DR
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City | HOLLAND
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State | MI
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Zip | 49424-8122
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Country | US
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Telephone | 616-396-1433
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 N WELLNESS DR
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City | HOLLAND
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State | MI
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Zip | 49424-8122
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Country | US
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Telephone | 616-396-1433
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | JASON T STUBBS
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Credential | DO
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Telephone | 812-639-4570
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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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Taxonomy #2
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State |
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