MEDICARE: PLASTIC SURGERY OF TUSCALOOSA INC

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	2086S0122X	Plastic and Reconstructive Surgery Physician

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	:	1316014681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLASTIC SURGERY OF TUSCALOOSA INC

Provider Business Mailing Address
First Line	:	1847 COMMONS NORTH DR STE A
Second Line	:
City	:	TUSCALOOSA
State	:	AL
Zip	:	35406-3700
Country	:	US
Telephone Number	:	205-349-0049
Fax Number	:	659-734-2003

Provider Business Practice Location Address
First Line	:	1847 COMMONS NORTH DR STE A
Second Line	:
City	:	TUSCALOOSA
State	:	AL
Zip	:	35406-3700
Country	:	US
Telephone Number	:	205-349-0049
Fax Number	:	659-734-2003

Authorized Official
Title or Position	:	INSURANCE
Name	:	MARQUIS HESTER
Credential	:
Telephone Number	:	205-349-0049

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	10/03/2023

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