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Organization
PLASTIC SURGERY CENTER OF ST JOSEPH, INC
Active
Organization
PLASTIC SURGERY CENTER OF ST JOSEPH, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL D DE PRIEST MD (MEDICAL DIRECTOR)
(816) 364-6446
Entity
Organization
Contact information
Practice address
2111 N WOODBINE RD, SAINT JOSEPH, MO 64506-2440
(816) 364-6416
(816) 364-5320
Mailing address
2111 N WOODBINE RD, SAINT JOSEPH, MO 64506-2440
(816) 364-6416
(816) 364-5320
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
136-0
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
136-0
STATE LICENSE NUMBER
MO
05
—
509336905
—
MO
Enumeration date
06/22/2005
Last updated
12/31/2014
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