Woodbury Plastic Surgery PA

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

47379 Issued in MN

Legal business name

WOODBURY PLASTIC SURGERY PA

Practice address

604 Bielenberg Dr
Ste 250
Woodbury, MN 55125-1414

Phone

(651) 730-4100

Fax

(651) 730-4107

NPI assigned

Apr 10, 2007

Last updated

Dec 14, 2012By 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

Ms. Malay L Thao

Title

Office Manager

Phone

(651) 730-4100

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• David Thao Plastic Surgery Other name

Locations

Practitioners 1

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.

• Calsey E Fasching, PSY.D.

  • Clinical Neuropsychologist
  • Oakdale, MN
  • NPI 1194232975
  NPD (past)

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355443200000",
    "number": "1225151418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 BIELENBERG DR",
            "address_2": "STE 250",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551251414",
            "telephone_number": "651-730-4100",
            "fax_number": "651-730-4107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 BIELENBERG DR",
            "address_2": "STE 250",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551251414",
            "telephone_number": "651-730-4100",
            "fax_number": "651-730-4107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODBURY PLASTIC SURGERY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2012-12-14",
        "status": "A",
        "authorized_official_last_name": "THAO",
        "authorized_official_first_name": "MALAY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "651-730-4100",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "MN",
            "license": "47379",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "430093900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "David Thao Plastic Surgery",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Woodbury Surgery Center, LLC

• Medical Specialty Clinic/Center in Woodbury, MN
• Providers in Woodbury, MN by specialty
• Medical Specialty Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2012; 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.