East Alabama Plastic Surgery, LLC
Organization Active NPI Plastic Surgery Physician · Auburn, AL
NPI 1659634624 · NPPES record last updated Jun 24, 2012
Key facts
- NPI
- 1659634624
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Plastic Surgery Physician 208200000X
- License
- MD.31455 (AL)
- Legal business name
- EAST ALABAMA PLASTIC SURGERY, LLC
- Practice address
- 778 N Dean Rd
Suite 400
Auburn, AL 36830-4312 - Phone
- (334) 321-4989
- NPI assigned
- Jun 24, 2012
- Organization subpart
- No
Authorized official
- Name
- Dr. Ralph L Aquadro III, M.D.
- Title
- LLC Member
- Phone
- (334) 321-4989
Practitioners 3
-
Grant Alexander Bond, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120709000505 | AL | Part B Supplier - Clinic/Group Practice | 4486819901 |
Receives reassigned benefits from 2 practitioners Practice locations: Auburn, AL |
National Provider Directory
Locations
778 N Dean Rd
Ste 400
Auburn, AL 36830
Phone (334) 321-4989
1935 E Glenn Ave
Ste 102
Auburn, AL 36830
Phone (334) 321-4989
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/JDIIBA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician |
208200000X | MD.31455 | AL | Yes |
Addresses
Primary practice location
778 N Dean Rd
Suite 400
Auburn, AL 36830-4312
Mailing address
778 N Dean Rd
Suite 400
Auburn, AL 36830-4312
Phone (334) 321-4989
Other providers in Auburn, AL
- East Alabama Medical Center Homecare, LLC
- East Alabama Neurosurgery and Spine
- East Alabama Occupational Medicine
- East Alabama Optical Shop, LLC
- East Alabama Pediatric Dentistry & Orthodontics
- East Alabama Primary Care, LLC
- East Alabama Services for the Elderly, Inc.
- East Alabama Specialty Therapy Clinic, LLC
- Shelby Odom Easter
- Kimble Eastman
All providers in Auburn, AL · Plastic Surgery Physician in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 24, 2012. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.