Provider Demographics
NPI:1386771996
Name:CENTER FOR COSMETIC & PLASTIC SURGERY, INC.
Entity type:Organization
Organization Name:CENTER FOR COSMETIC & PLASTIC SURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-770-6776
Mailing Address - Street 1:1353 E MCANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6105
Mailing Address - Country:US
Mailing Address - Phone:541-770-6776
Mailing Address - Fax:541-608-7482
Practice Address - Street 1:1353 E MCANDREWS RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6105
Practice Address - Country:US
Practice Address - Phone:541-770-6776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000DBCBGMedicare ID - Type UnspecifiedMEDICARE