Provider Demographics
NPI:1154186781
Name:PREMIER SCULPTING, PLLC
Entity type:Organization
Organization Name:PREMIER SCULPTING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:R DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGERTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-904-9000
Mailing Address - Street 1:307 W 6TH AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2540
Mailing Address - Country:US
Mailing Address - Phone:509-904-9000
Mailing Address - Fax:509-703-7799
Practice Address - Street 1:307 W 6TH AVE STE 104
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2540
Practice Address - Country:US
Practice Address - Phone:509-904-9000
Practice Address - Fax:509-703-7799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty