Organization
PREMIER PLASTIC SURGERY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JOHN B MOORE IV MD (PARTNER)
(913) 782-0707
Entity
Organization
Contact information
Practice address
20375 W 151 ST STREET, SUITE 370, OLATHE, KS 66061
(913) 782-0280
Mailing address
20375 W 151 ST STREET, SUITE 370, OLATHE, KS 66061
(913) 782-0280
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24300011
BLUE CROSS
KS
Enumeration date
05/03/2007
Last updated
07/06/2011
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