MEDICARE: PLASTIC SURGERY CENTER, 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	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1609996230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLASTIC SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	11999 SAN VICENTE BLVD
Second Line	:	STE. 440
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-5131
Country	:	US
Telephone Number	:	310-440-3131
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 FOREST HILL BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-6000
Country	:	US
Telephone Number	:	561-304-0001
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KRIS REDDY
Credential	:	M.D.
Telephone Number	:	561-304-0001

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	08/22/2020

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