NPIMap

Organization Active NPI

West County Plastic & Reconstructive Surgery, Inc.

  • Clinic/Center
  • Chesterfield, MO
National Provider Identifier
1386951028
Registry record updated Sep 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
WEST COUNTY PLASTIC & RECONSTRUCTIVE SURGERY, INC.
Practice address
222 S Woods Mill Rd
Suite 700 North
Chesterfield, MO 63017-3625
Phone
(314) 878-7770
Fax
(314) 878-2746
NPI assigned
Sep 1, 2010
Last updated
Sep 1, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2010

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

Authorized official

Name
Dr. Charles David Ettelson, M.D.
Title
President/Owner
Phone
(314) 878-7770

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

222 S Woods Mill Rd
Suite 700 North
Chesterfield, MO 63017-3625

Mailing address

222 S Woods Mill Rd
Suite 700 North
Chesterfield, MO 63017-3625
Phone (314) 878-7770

National Provider Directory

National Provider Directory

Locations

222 S Woods Mill Rd
Ste 700N
Chesterfield, MO 63017
Phone (314) 878-7770

NPI Registry JSON

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

{
    "created_epoch": "1283299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283299200000",
    "number": "1386951028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 S WOODS MILL RD",
            "address_2": "SUITE 700 NORTH",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630173625",
            "telephone_number": "314-878-7770",
            "fax_number": "314-878-2746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 S WOODS MILL RD",
            "address_2": "SUITE 700 NORTH",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630173625",
            "telephone_number": "314-878-7770",
            "fax_number": "314-878-2746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST COUNTY PLASTIC & RECONSTRUCTIVE SURGERY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-01",
        "last_updated": "2010-09-01",
        "status": "A",
        "authorized_official_last_name": "ETTELSON",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "314-878-7770",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesterfield, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2010; 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.