NPIMap

Organization Active NPI

Fayetteville Plastic Surgery Specialists, PA

  • Plastic Surgery Physician
  • Fayetteville, NC
National Provider Identifier
1093808388
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
27390 Issued in NC
Legal business name
FAYETTEVILLE PLASTIC SURGERY SPECIALISTS, PA
Practice address
1774 Metromedical Dr
Fayetteville, NC 28304-3861
Phone
(910) 323-1203
Fax
(910) 483-1130
NPI assigned
Oct 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Horace William Miller IV, MDNPI 1376636654
Title
President
Phone
(910) 323-1203

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208200000X 27390 NC Primary

Addresses

Primary practice location

1774 Metromedical Dr
Fayetteville, NC 28304-3861

Mailing address

1774 Metromedical Dr
Fayetteville, NC 28304-3861
Phone (910) 323-1203

Other identifiers 1

IdentifierTypeStateIssuer
8959118MedicaidNC

National Provider Directory

National Provider Directory

Locations

1774 Metromedical Dr
Fayetteville, NC 28304
Phone (910) 323-1203

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1159660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093808388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1774 METROMEDICAL DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043861",
            "telephone_number": "910-323-1203",
            "fax_number": "910-483-1130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1774 METROMEDICAL DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043861",
            "telephone_number": "910-323-1203",
            "fax_number": "910-483-1130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTEVILLE PLASTIC SURGERY SPECIALISTS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "HORACE",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "910-323-1203",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "IV",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": "NC",
            "license": "27390",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8959118",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.