Provider Demographics
NPI:1063185478
Name:PNW PLASTIC SURGERY LLC
Entity type:Organization
Organization Name:PNW PLASTIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:J
Authorized Official - Last Name:URBINELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-749-5512
Mailing Address - Street 1:5305 RIVER RD N STE B
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-5324
Mailing Address - Country:US
Mailing Address - Phone:503-749-5512
Mailing Address - Fax:
Practice Address - Street 1:5305 RIVER RD N STE B
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-5324
Practice Address - Country:US
Practice Address - Phone:503-749-5512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty