SOUTHEASTERN PLASTIC SURGERY ASSOC., PC (NPI# 1124168927) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124168927 |
| Entity Type | Organization |
| Organization Name | SOUTHEASTERN PLASTIC SURGERY ASSOC., PC |
| Practice Address |
100 Towncenter Suite 111 Tuscaloosa AL 35406-1832 |
| Practice Telephone | 2053458820 |
| Practice Fax Number | 2053458842 |
| Mailing Telephone | 2053458820 |
| Mailing Fax Number | 2053458842 |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2012-03-27 |
| Authorized Official Name | DR. LUIS R PERNIA (SURGEON) |
| Authorized Official Telephone | 2053458820 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 10631 | AL | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | BCBS OF MS | 441666528B | 01 |
| AL | BCBS OF AL | 51014573 | 01 |
| MS | MEDICARE | 240000037 | 01 |
| AL | 528501310 | 05 |
| Street Address |
100 TOWNCENTER SUITE 111 |
| City | TUSCALOOSA |
| State | AL |
| Zip Code | 35406-1832 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134757735 | Susan Tingle Mills | Counselor | 1470 Northbank Parkway, Tuscaloosa, AL 35406 | 2020-03-30 |
| 1508416314 | Carehere LLC | Family Medicine | Carehere Clinic-mercedes Tuscaloosa Health and Wellness, 971 Fairfax Park, Suite B, Tuskaloosa, AL 35406 | 2019-09-13 |
| 1093275364 | Medfusions | Nurse Anesthetist, Certified Registered | 120 Rice Mine Road N, Tuscaloosa, AL 35406 | 2019-03-22 |
| 1891144259 | Gregory Chad Green, Od, PC | Optometrist | 1490 Northbank Parkway, Suite 120, Tuscaloosa, AL 35406 | 2016-06-07 |
| 1164767083 | First Care LLC | Clinic/Center | 1251 Mcfarland Blvd. Ne, Tuscaloosa, AL 35406 | 2012-12-04 |
| 1144520487 | Ladonna Demetrice Snider | Registered Nurse | 825 Rice Mine Road No., Tuscaloosa, AL 35406 | 2010-11-02 |
| 1699923102 | Nancy M. Tactuk Romanenko | Internal Medicine | 1015 Rice Valley Rd N, Tuscaloosa, AL 35406 | 2008-09-09 |
| 1912042433 | Patrick Bruce Atkins | Psychiatry & Neurology | 1649 Mcfarland Boulevard North, Suite 201, Tuscaloosa, AL 35406 | 2007-02-21 |
| 1073663555 | Mark Linden Prohaska | Clinical Neuropsychologist | 100 Rice Mine Road, Suite 303, Tuscaloosa, AL 35406 | 2007-01-10 |
| 1225197155 | Jane Watkins Phd | Counselor | 150 Rice Mine Road, Suite B, Tuscalcosa, AL 35406 | 2006-12-06 |
| Find all providers in zip 35406 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598248205 | Almatriga Vladzetta Essex | Specialist | 1110 15th St Ste G, Tuscaloosa, AL 35401-3393 | 2018-09-09 |
| 1942679089 | Laujwinae Gardner | Specialist | 7204 Hud Ln, Tuscaloosa, AL 35405-6229 | 2015-09-18 |
| 1861772626 | Sam Chen | Specialist | Univ of Al Rec, 401 5th Ave E, Tuscaloosa, AL 35487-0001 | 2011-08-25 |
| 1770870149 | Mednet West, Inc. | Specialist | 3816 Palisades Drive, Suite B, Tuscaloosa, AL 35405-3451 | 2011-07-06 |
| 1700986650 | Skilled Neurology Inc | Specialist | 33 Ridgeland, Tuscaloosa, AL 35406-1607 | 2006-09-22 |
| 1760455950 | Edward D Hillard | Specialist | 900 Anna Ave, Tuscaloosa, AL 35401-2014 | 2006-02-09 |
| 1316910854 | John William Morr | Specialist | The University of Alabama, Box 870393, Tuscaloosa, AL 35487-0001 | 2006-02-07 |
| 1962474775 | Sherry Lou Kimbro | Specialist | 1201 Coliseum Drive, Coliseum Athletic Training Room, Tuscaloosa, AL 35487-0001 | 2006-02-06 |
| 1780241323 | Studiov Hlc | Specialist | 1110 15th St Ste G, Tuscaloosa, AL 35401-3393 | 2019-05-20 |
| 1548646003 | Invision Optical | Specialist | 2117 University Blvd, Tuscaloosa, AL 35401-1539 | 2015-08-07 |
| Find all providers in TUSCALOOSA | ||||
| City | TUSCALOOSA |
| Zip Code | 35406 |
Please comment or provide details below to improve the information on SOUTHEASTERN PLASTIC SURGERY ASSOC., PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.