COSMETICS AND PLASTIC SURGERY – NPI #1619273927
Surgery

A surgeon who specializes in plastic and reconstructive surgery.

COSMETICS AND PLASTIC SURGERY is a surgeon located in FARGO, ND. NPPES has assigned the NPI number 1619273927 to COSMETICS AND PLASTIC SURGERY on February 03, 2011. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “COSMETICS AND PLASTIC SURGERY” is a dba name, the actual legal business name for this organization is AVERA ST. LUKE'S. The primary taxonomy selected by this provider is 2086S0122X from the Health Care Provider Taxonomy code set, which is classified as Surgery, specializing in Plastic and Reconstructive Surgery

The NPI profile was previously updated about 15 years ago on Jun 30, 2011. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for COSMETICS AND PLASTIC SURGERY below.

NPI Profile for
AVERA ST. LUKE'S

NPI Number
1619273927
Enumeration Date

(more than 15 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
AVERA ST. LUKE'S
Doing Business As (dba): COSMETICS AND PLASTIC SURGERY
Primary location
4141 31ST AVE S STE 105
FARGO, ND 58104-8778
Phone: (605) 725-5030 Fax: (605) 725-5028
Mailing address
PO BOX 1460
ABERDEEN, SD 57402-1460
Phone: (605) 725-5030 Fax: (605) 725-5028
Organization Subpart
No
Authorized Official
RON JACOBSON
CEO
Phone: (605) 622-5125
Updated
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
2086S0122X
- Surgery / Plastic and Reconstructive Surgery (Primary)
SD 10525

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.