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General NPI Number Information
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NPI Number | 1861522922
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Entity Type | Organization
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Legal Business Name | FOOTHILLS PLASTIC SURGERY, LLC
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 2755 S HIGHWAY 14 SUITE 2150
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City | GREER
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State | SC
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Zip | 29650-4902
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Country | US
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Telephone | 864-288-8118
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Fax | 864-288-8113
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Provider Business Mailing Address
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Address Line | 2755 S HIGHWAY 14 SUITE 2150
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City | GREER
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State | SC
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Zip | 29650-4902
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Country | US
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Telephone | 864-288-8118
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Fax | 864-288-8113
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Authorized Official
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Title or Position | OWNER
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Name | DR. W. JOHN SUBER
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Credential | M.D.
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Telephone | 864-288-8118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 21476
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License Number State | SC
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