Provider Demographics
NPI:1720245665
Name:THE PLASTIC AND COSMETIC CENTER OF SOUTH TEXAS
Entity type:Organization
Organization Name:THE PLASTIC AND COSMETIC CENTER OF SOUTH TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:TAYF
Authorized Official - Last Name:JENEBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-270-8595
Mailing Address - Street 1:7272 WURZBACH RD
Mailing Address - Street 2:UNIT 801
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4801
Mailing Address - Country:US
Mailing Address - Phone:210-270-8595
Mailing Address - Fax:210-270-8595
Practice Address - Street 1:7272 WURZBACH RD
Practice Address - Street 2:UNITE 801
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-4801
Practice Address - Country:US
Practice Address - Phone:210-270-8595
Practice Address - Fax:210-270-8988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9748174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00938XMedicare PIN