MEDICARE: PLASTIC SURGERY CONSULTANTS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	19438	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245319094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLASTIC SURGERY CONSULTANTS, LLC

Provider Business Mailing Address
First Line	:	1220 BLANDING ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2816
Country	:	US
Telephone Number	:	803-779-1200
Fax Number	:	803-779-1220

Provider Business Practice Location Address
First Line	:	1220 BLANDING ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2816
Country	:	US
Telephone Number	:	803-779-1200
Fax Number	:	803-779-1220

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. RICHARD J WASSERMANN
Credential	:	M.D., MPH, FACS
Telephone Number	:	803-779-1200

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	10/12/2011

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