NPIMap

Organization Active NPI

Advanced Plastic Surgery, PC

  • Ambulatory Surgical Clinic/Center
  • Grand Rapids, MI
National Provider Identifier
1497425508
Registry record updated Sep 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
ADVANCED PLASTIC SURGERY, PC
Practice address
3855 Burton St SE Ste a
Grand Rapids, MI 49546-6147
Phone
(616) 323-3102
Fax
(616) 323-3061
NPI assigned
Sep 20, 2021
Organization subpart
Yes
Parent organization
ADVANCED PLASTIC SURGERYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 20, 2021

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

Authorized official

Name
Ewa D Komorowska-Timek, MDNPI 1710996319
Title
Physician Owner
Phone
(616) 323-3102

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

3855 Burton St SE Ste a
Grand Rapids, MI 49546-6147

Mailing address

3855 Burton St SE Ste a
Grand Rapids, MI 49546-6147
Phone (616) 323-3102

Other names 1

  • Advanced Plastic Surgical Center Other name

National Provider Directory

National Provider Directory
Tax ID family
Advanced Plastic Surgery PC3 organizations share this tax ID, including this one
Part of
Advanced Plastic Surgery PC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3855 Burton St SE
Ste A
Grand Rapids, MI 49546
Phone (616) 323-3102

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1632096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632096000000",
    "number": "1497425508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3855 BURTON ST SE STE A",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495466147",
            "telephone_number": "616-323-3102",
            "fax_number": "616-323-3061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3855 BURTON ST SE STE A",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495466147",
            "telephone_number": "616-323-3102",
            "fax_number": "616-323-3061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED PLASTIC SURGERY, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ADVANCED PLASTIC SURGERY",
        "enumeration_date": "2021-09-20",
        "last_updated": "2021-09-20",
        "certification_date": "2021-09-20",
        "status": "A",
        "authorized_official_last_name": "KOMOROWSKA-TIMEK",
        "authorized_official_first_name": "EWA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "616-323-3102",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Plastic Surgical Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2021; 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.