Provider Demographics
NPI:1700247202
Name:FREDERICK RECONSTRUCTIVE SERVICES LLC
Entity type:Organization
Organization Name:FREDERICK RECONSTRUCTIVE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-827-8159
Mailing Address - Street 1:5205 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4500
Mailing Address - Country:US
Mailing Address - Phone:631-827-8159
Mailing Address - Fax:
Practice Address - Street 1:5205 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4500
Practice Address - Country:US
Practice Address - Phone:631-827-8159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty