The Park Clinic for Cosmetic and Reconstructive Surgery, P.C.

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

MD.28938 Issued in AL

Legal business name

THE PARK CLINIC FOR COSMETIC AND RECONSTRUCTIVE SURGERY, P.C.

Practice address

3153 Dauphin St
Mobile, AL 36606-4061

Phone

(251) 340-6600

NPI assigned

Sep 3, 2008

Organization subpart

Yes

Parent organization

MOBILE PLASTIC AND RECONSTRUCTIVE SURGERY AND DERMATOLOGYAs reported in NPPES

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

Authorized official

Name

Christopher A Park, M.D.NPI 1497885339

Title

President

Phone

(251) 340-6600

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Locations

Practitioners 5

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

• Christopher A Park, M.D.

  • Plastic Surgery Physician
  • Mobile, AL
  • NPI 1497885339
  Medicare reassignment Care Compare group NPD Authorized official
• Matthew May, MD

  • Facial Plastic Surgery Physician
  • Mobile, AL
  • NPI 1205290962
  Medicare reassignment Care Compare group NPD
• Ryan Edward Rebowe, M.D.

  • Plastic Surgery Physician
  • Mobile, AL
  • NPI 1508203456
  Medicare reassignment Care Compare group NPD
• Lindsey C Beville, PA

  • Physician Assistant
  • Mobile, AL
  • NPI 1114025731
  Medicare reassignment Care Compare group
• Megan Vallance McNeil, NP

  • Adult Health Nurse Practitioner
  • Lexington, KY
  • NPI 1730644824

  AL

  Medicare reassignment NPD

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

{
    "created_epoch": "1220400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237334400000",
    "number": "1821246869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 852047",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366852047",
            "telephone_number": "251-340-6600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3153 DAUPHIN ST",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366064061",
            "telephone_number": "251-340-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PARK CLINIC FOR COSMETIC AND RECONSTRUCTIVE SURGERY, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOBILE PLASTIC AND RECONSTRUCTIVE SURGERY AND DERMATOLOGY",
        "enumeration_date": "2008-09-03",
        "last_updated": "2009-03-18",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "251-340-6600",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "AL",
            "license": "MD.28938",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "510G700432",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PTAN",
            "identifier": "510G700432",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD AL",
            "identifier": "51595045",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Medical Specialty Clinic/Center in Mobile, AL
• Providers in Mobile, AL by specialty
• Medical Specialty Clinic/Center in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2009; 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.