Excel Cosmetic Surgery Center

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

3591001205 Issued in UT

Legal business name

EXCEL COSMETIC SURGERY CENTER

Practice address

1735 N State St
Provo, UT 84604-1010

Phone

(801) 379-2900

Fax

(801) 374-6295

NPI assigned

Mar 9, 2007

Last updated

Aug 19, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Dale Blake

Title

Administrator

Phone

(801) 374-1818

Specialties & licenses 1

Addresses

Other names 1

• Central Utah Eye Associates Other name

Medicare fee-for-service enrollment

Enrolled in UT

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, and the practitioner matching its NPPES authorized official.

• Todd B Engen, MD

  • Ophthalmic Plastic and Reconstructive Surgery Physician
  • Provo, UT
  • NPI 1295705697
  Medicare reassignment NPD
• Scott Walden Yeates, MD

  • Ophthalmology Physician
  • Orem, UT
  • NPI 1588818645
  NPD (past)

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219104000000",
    "number": "1851422703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1735 N STATE ST",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846041010",
            "telephone_number": "801-379-2900",
            "fax_number": "801-374-6295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1735 N STATE ST",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846041010",
            "telephone_number": "801-379-2900",
            "fax_number": "801-374-6295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCEL COSMETIC SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-09",
        "last_updated": "2008-08-19",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "DALE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "801-374-1818",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "UT",
            "license": "3591001205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Utah Eye Associates",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Morgan Emily Evans
• Raeleigh Janae Evans
• Richard Michael Evans
• Scott Delafield Evans, MD
• Tamara Jean Ewan, NURSE PRACTITIONER
• Expanding Autistic Borders LLC
• Eye Clinic & Contact Lens Center of Utah Valley PC (Eye Clinic & Aesthetics of Provo)
• Eye Clinic & Contact Lens Center of Utah Valley PC
• Aleea Eyre
• Janalee Eyre

• Plastic and Reconstructive Surgery Physician in Provo, UT
• Providers in Provo, UT by specialty
• Plastic and Reconstructive Surgery Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2008; 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.