Facial Plastic & Laser Surgery

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

FACIAL PLASTIC & LASER SURGERY

Practice address

7301 N Knoxville Ave
Peoria, IL 61614-2017

Phone

(309) 589-3233

Fax

(309) 689-0312

NPI assigned

Dec 18, 2006

Last updated

Jul 21, 2022By 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

Mr. Robert J Tudor II

Title

Chief Executive Officer

Phone

(309) 589-8053

Specialties & licenses 1

Addresses

Other names 1

• Facial Plastic & Laser Surgery Center, LLC Other name

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Peoria Ear, Nose and Throat Group, S.C.

  • Otolaryngology Physician
  • Peoria, IL
  • NPI 1952380628

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1194888677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7301 N KNOXVILLE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616142017",
            "telephone_number": "309-589-3233",
            "fax_number": "309-689-0312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7301 N KNOXVILLE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616142017",
            "telephone_number": "309-589-3233",
            "fax_number": "309-689-0312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FACIAL PLASTIC & LASER SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "TUDOR",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "309-589-8053",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "II"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Facial Plastic & Laser Surgery Center, LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Diane Ewers, CRNA
• Extended Pharmacy LLC
• Stephen J Eyler, MD
• Mark O Fabish, PHYSICAL THERAPIST
• Natasha Sementa Fable, MD, MPH, MS
• Emily Fahey, MD
• Kevin M Fahey, MD
• Timothy Eamon Fahey, M.D.
• Jeanetta Fahrner
• Ryan Fairchild

• Clinic/Center in Peoria, IL
• Providers in Peoria, IL by specialty
• Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.