Provider Demographics
NPI:1306053327
Name:MENARD, PLASTIC SURGERY LLC
Entity type:Organization
Organization Name:MENARD, PLASTIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MENARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-391-9038
Mailing Address - Street 1:401 TOWNCENTER BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-1822
Mailing Address - Country:US
Mailing Address - Phone:205-391-9038
Mailing Address - Fax:205-391-4688
Practice Address - Street 1:401 TOWNCENTER BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-1822
Practice Address - Country:US
Practice Address - Phone:205-391-9038
Practice Address - Fax:205-391-4688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14811208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL101002Medicaid
AL101002Medicaid