Plastic Surgery Center of Lake County

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

1049 Issued in FL

Legal business name

PLASTIC SURGERY CENTER OF LAKE COUNTY

Doing business as

Bosshardt & Marzek Plastic Surgery Associates

Practice address

1879 Nightingale LN
A-2
Tavares, FL 32778-4363

Phone

(352) 742-0079

Fax

(352) 742-0059

NPI assigned

Jul 3, 2006

Last updated

Jun 18, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Vera D. Renfro

Title

Office Administrator

Phone

(352) 742-0079

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Bosshardt & Marzek Plastic Surgery Associates Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Plastic Surgery Center of Lake County, P.a.

  dba Bosshardt and Marzek , Plastic Surgery Associates

  • Plastic Surgery Physician
  • Tavares, FL
  • NPI 1790881654

  2860685468

  Same PAC ID

Listed as

Plastic Surgery Center of Lake CountyCCN 10C0001279

Medicare certification status

ActiveFrom the Provider of Services file

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213747200000",
    "number": "1073543310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1879 NIGHTINGALE LN",
            "address_2": "A-2",
            "city": "TAVARES",
            "state": "FL",
            "postal_code": "327784363",
            "telephone_number": "352-742-0079",
            "fax_number": "352-742-0059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1879 NIGHTINGALE LN",
            "address_2": "A-2",
            "city": "TAVARES",
            "state": "FL",
            "postal_code": "327784363",
            "telephone_number": "352-742-0079",
            "fax_number": "352-742-0059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLASTIC SURGERY CENTER OF LAKE COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-03",
        "last_updated": "2008-06-18",
        "status": "A",
        "authorized_official_last_name": "RENFRO",
        "authorized_official_first_name": "VERA",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "352-742-0079",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "FL",
            "license": "1049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "252761801",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AND SHIELD FL",
            "identifier": "6B8",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "490003374",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bosshardt & Marzek Plastic Surgery Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Anni Pettis
• Ronald Pierre-Louis, APRN
• Melanie Pigott, LMHC
• Pioneer Managed Care LLC
• Elena Pizarro, AUD
• Plastic Surgery Center of Lake County, P.a. (Bosshardt and Marzek , Plastic Surgery Associates)
• Cynthia J. Popa, DDS
• Erica Humphrey Powell, CRNA
• Powerback Rehabilitation LLC
• Rosa Maria Prado, RMHCI

• Ambulatory Surgical Clinic/Center in Tavares, FL
• Providers in Tavares, FL by specialty
• Ambulatory Surgical Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.