Defatta Ent & Facial Plastic Surgery Sc

LBN: Defatta Ent & Facial Plastic Surgery Sc
Defatta Ent & Facial Plastic Surgery Sc is an health care organization with primary practice located at 1490 Rivers Edge Trail , Altoona WI 54720-1495. The organization recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Ambulatory Health Care Facilities / Medical Specialty. Other Service Providers / Specialist is the primary health care specialty. Defatta Ent & Facial Plastic Surgery Sc can be contacted via phone (715) 828-2368, or through Defatta, Robert Joseph via phone (715) 828-2368.

Contact Information

Primary practice address
1490 Rivers Edge Trail Altoona WI 54720-1495
Phone: (715) 828-2368
Fax: (715) 726-2087
Website:
Map and Directions
Authorized official contact:
Name: Defatta, Robert Joseph MD, PH D, FACS
Phone: (715) 828-2368

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 55984-20 Wisconsin
Ambulatory Health Care Facilities / Medical Specialty 261QM2500X 55984-20 Wisconsin

Profile Details

NPI number 1346664059
LBN Legal business name Defatta Ent & Facial Plastic Surgery Sc
DBA Doing business as
Authorized official Defatta, Robert Joseph MD, PH D, FACS
Entity Organization
Organization subpart 1 No
Enumeration date Feb 17th, 2014
Last updated May 5th, 2014 - about 10 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1346664059 NPPES
Wisconsin Other 1578697520 NPI
Wisconsin MEDICAID 100016459 NPI
Wisconsin Other 1790931707 NPI

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