NPIMap

Organization Active NPI

Parkcrest Plastic Surgery, Inc.

  • Plastic and Reconstructive Surgery Physician
  • Saint Louis, MO
National Provider Identifier
1073676755
Registry record updated Mar 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
Legal business name
PARKCREST PLASTIC SURGERY, INC.
Practice address
845 N. New Ballas Court
Suite 300
Saint Louis, MO 63141-7083
Phone
(314) 569-9413
Fax
(314) 569-3674
NPI assigned
Dec 18, 2006
Last updated
Mar 3, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2008

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

Authorized official

Name
Ms. Deborah Sue Williams
Title
Office Manager
Phone
(314) 569-9413

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic and Reconstructive Surgery Physician 2086S0122X NU Primary

Addresses

Primary practice location

845 N. New Ballas Court
Suite 300
Saint Louis, MO 63141-7083

Mailing address

845 N. New Ballas Court
Suite 300
Saint Louis, MO 63141-7083
Phone (314) 569-9413

Other identifiers 1

IdentifierTypeStateIssuer
CB3594OtherMORR MEDICARE

National Provider Directory

National Provider Directory

Locations

675 Old Ballas Rd
Ste 200
Saint Louis, MO 63141
Phone (314) 569-0057

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204502400000",
    "number": "1073676755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 N. NEW BALLAS COURT",
            "address_2": "SUITE 300",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631417083",
            "telephone_number": "314-569-9413",
            "fax_number": "314-569-3674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 N. NEW BALLAS COURT",
            "address_2": "SUITE 300",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631417083",
            "telephone_number": "314-569-9413",
            "fax_number": "314-569-3674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARKCREST PLASTIC SURGERY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2008-03-03",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "314-569-9413",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CB3594",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.