Advanced Plastic Surgery Center, L.L.C.
Organization Active NPI Ambulatory Surgical Clinic/Center · Prescott, AZ
NPI 1447458591 · NPPES record last updated Aug 16, 2007
Key facts
- NPI
- 1447458591
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ambulatory Surgical Clinic/Center 261QA1903X
- Legal business name
- ADVANCED PLASTIC SURGERY CENTER, L.L.C.
- Practice address
- 1615 Petroglyph Point Dr
Prescott, AZ 86301-6539 - Phone
- (928) 777-0200
- Fax
- (928) 443-1117
- NPI assigned
- Jul 10, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Mark D Fetter, M.D.
- Title
- Medical Director
- Phone
- (928) 777-0200
Medicare Care Compare: Ambulatory surgical center
- Listed as
- Advanced Plastic Surgery Center LLC
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 03D2091884 | Advanced Plastic Surgery Center | Certificate of waiver | Feb 19, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070816000286 | AZ | Part B Supplier - Ambulatory Surgical Center | 2365534674 | Practice locations: Prescott, AZ |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Surgical Clinic/Center | 261QA1903X | Yes |
Addresses
Primary practice location
1615 Petroglyph Point Dr
Prescott, AZ 86301-6539
Mailing address
1615 Petroglyph Point Dr
Prescott, AZ 86301-6539
Phone (928) 777-0200
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- Advanced Minimally Invasive Surgical
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All providers in Prescott, AZ · Ambulatory Surgical Clinic/Center in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 16, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.