NPIMap

Organization Active NPI

Premiere Plastic Cosmetic and Laser Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Kettering, OH
National Provider Identifier
1770631392
Registry record updated Dec 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
037634 Issued in OH
Legal business name
PREMIERE PLASTIC COSMETIC AND LASER SURGERY CENTER LLC
Practice address
3533 Southern Blvd
Suite 4400
Kettering, OH 45429-1264
Phone
(937) 294-9255
Fax
(937) 294-9256
NPI assigned
Jan 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2012

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

Authorized official

Name
Dr. Thomas Percy, M.D.
Title
President
Phone
(937) 294-9255

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 037634 OH Primary

Addresses

Primary practice location

3533 Southern Blvd
Suite 4400
Kettering, OH 45429-1264

Mailing address

3533 Southern Blvd
Suite 4400
Kettering, OH 45429-1264
Phone (937) 294-9255

Other identifiers 1

IdentifierTypeStateIssuer
3035227MedicaidOH

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1356652800000",
    "number": "1770631392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3533 SOUTHERN BLVD",
            "address_2": "SUITE 4400",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454291264",
            "telephone_number": "937-294-9255",
            "fax_number": "937-294-9256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3533 SOUTHERN BLVD",
            "address_2": "SUITE 4400",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454291264",
            "telephone_number": "937-294-9255",
            "fax_number": "937-294-9256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIERE PLASTIC COSMETIC AND LASER SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2012-12-28",
        "status": "A",
        "authorized_official_last_name": "PERCY",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "937-294-9255",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "OH",
            "license": "037634",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3035227",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kettering, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2012; 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.