Plastics Clinic LLC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

Legal business name

PLASTICS CLINIC LLC

Practice address

1309 W South Jordan Pkwy Ste 110
South Jordan, UT 84095-9014

Phone

(801) 839-5557

Fax

(801) 770-4455

NPI assigned

Jun 6, 2023

Last updated

Oct 31, 2023By 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

Tim Prusse

Title

Manager

Phone

(801) 386-1337

Specialties & licenses 1

Addresses

Locations

Practitioners 3

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.

• Danica Cross, RN

  • Plastic Surgery Physician
  • Draper, UT
  • NPI 1902736184
  NPD (past)
• Brenton Robinson, M.D.

  • Plastic Surgery Physician
  • Murray, UT
  • NPI 1598152852
  NPD (past)
• Rebecca Dawn Roy, FNP-C

  • Family Nurse Practitioner
  • Draper, UT
  • NPI 1023689080
  NPD (past)

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

{
    "created_epoch": "1686009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698710400000",
    "number": "1184318826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1309 W SOUTH JORDAN PKWY STE 110",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840959014",
            "telephone_number": "801-839-5557",
            "fax_number": "801-770-4455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1309 W SOUTH JORDAN PKWY STE 110",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840959014",
            "telephone_number": "801-839-5557",
            "fax_number": "801-770-4455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLASTICS CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-06",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "status": "A",
        "authorized_official_last_name": "PRUSSE",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "801-386-1337"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Wallace Pincock, CMHC
• Pinnacle Medical Consultants
• Emily Pinnock, PHARMD
• Pivotal Trauma Counseling LLC
• Planned Parenthood Association of Utah
• Catherine T Platt, PA
• Plume Health, PC
• Plunkett Family Health (Stephanie Plunkett, MD)
• Stephanie Plunkett, MD
• Payton Joy Pola, CSW

• Plastic Surgery Physician in South Jordan, UT
• Providers in South Jordan, UT by specialty
• Plastic Surgery Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2023; 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.