Plastic Surgery & Weight Loss CNTR

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

101644 Issued in MO

Legal business name

PLASTIC SURGERY & WEIGHT LOSS CNTR

Practice address

10994 Historic Highway 165 Ste D
Hollister, MO 65672-5606

Phone

(417) 239-0079

Fax

(417) 239-1228

NPI assigned

Sep 18, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Marian W Stewart, DONPI 1518911676

Title

Officer

Phone

(417) 239-0079

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 2

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

• Marian W Stewart, D.O.

  • Plastic and Reconstructive Surgery Physician
  • Hollister, MO
  • NPI 1518911676
  Medicare reassignment NPD Authorized official
• Thomas William Holtgrave, A.P.N.

  • Women's Health Nurse Practitioner
  • Branson, MO
  • NPI 1588663165
  NPD (past)

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

{
    "created_epoch": "1190073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366070400000",
    "number": "1699961193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8781",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658018781",
            "telephone_number": "417-239-0079",
            "fax_number": "417-239-1228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10994 HISTORIC HIGHWAY 165 STE D",
            "city": "HOLLISTER",
            "state": "MO",
            "postal_code": "656725606",
            "telephone_number": "417-239-0079",
            "fax_number": "417-239-1228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLASTIC SURGERY & WEIGHT LOSS CNTR",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-18",
        "last_updated": "2013-04-16",
        "status": "A",
        "authorized_official_last_name": "STEWART",
        "authorized_official_first_name": "MARIAN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "417-239-0079",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "MO",
            "license": "101644",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DD0320",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "244744504",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD NON-PART",
            "identifier": "10014M",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF KC",
            "identifier": "21186039",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Merdina Nash, M.S., CCC-SLP
• Brandon Neds, PT
• Courtney Notley, DDS
• Kerrie Nell Patton, P.T.
• Nezerae Rose Phillips, LMSW
• Jeffrey Scott Rick, D.D.S.
• Trevor B Rick, DDS
• Melonie Renee Roberts, FNP-BC
• Roller Enterprises LLC
• John Orville Roller, D.P.M.

• Medical Specialty Clinic/Center in Hollister, MO
• Providers in Hollister, MO by specialty
• Medical Specialty Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.