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General NPI Number Information
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NPI Number | 1881765337
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Entity Type | Organization
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Legal Business Name | MIDWEST PLASTIC SURGERY AND LASER CENTER, LLC
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4820 S ARROWHEAD DR
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City | INDEPENDENCE
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State | MO
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Zip | 64055-6980
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Country | US
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Telephone | 816-795-5262
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Fax | 816-795-8979
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Provider Business Mailing Address
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Address Line | 4820 S ARROWHEAD DR
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City | INDEPENDENCE
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State | MO
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Zip | 64055-6980
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Country | US
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Telephone | 816-795-5262
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Fax | 816-795-8979
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEROME P. LAMB
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Credential | M.D.
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Telephone | 816-795-5262
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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 | 85-9
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License Number State | MO
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