ALLOPLASTIC RECONSTRUCTION (NPI# 1962805812) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962805812 |
| Entity Type | Organization |
| Organization Name | ALLOPLASTIC RECONSTRUCTION |
| Other Organization Name | THE CENTER FOR ALLOPLASTIC FACIAL RECONSTRUCTION |
| Practice Address |
6 W Ge Patterson Ave Suite 102 Memphis TN 38103-6413 |
| Mailing Address |
220 N. Van Buren Little Rock AR 72205 |
| Practice Telephone | 9014105375 |
| Practice Fax Number | 8009774149 |
| Mailing Telephone | 5012650100 |
| Mailing Fax Number | 8009774149 |
| Enumeration Date | 2014-10-07 |
| Last Update Date | 2015-01-09 |
| Authorized Official Name | MR. MICHAEL D KACZKOWSKI (PRESIDENT) |
| Authorized Official Telephone | 5012650100 |
| Is Organization Subpart | Y |
| Parent Organization Name | ALLOPLASTIC RECONSTRUCTION |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 156FX1700X |
Technician/Technologist Specialization: Ocularist |
Eye and Vision Services Providers | ||
| N | 335E00000X | Prosthetic/Orthotic Supplier | OPP00038 | AR | Suppliers |
| Y | 229N00000X | Anaplastologist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Other Name | Type Code |
|---|---|
| THE CENTER FOR ALLOPLASTIC FACIAL RECONSTRUCTION | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598049744 | Alloplastic Reconstruction | Anaplastologist | 3924 W Markham St, Little Rock, AR 72205-5528 | 2011-10-06 |
| Street Address |
6 W GE PATTERSON AVE SUITE 102 |
| City | MEMPHIS |
| State | TN |
| Zip Code | 38103-6413 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770622177 | Silicone Ocular | Clinical Medical Laboratory | 6 W Ge Patterson Ave, Suite 101, Memphis, TN 38103-6413 | 2007-02-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619505724 | Michelle Lynn Esposito | Dietitian, Registered | 1st Floor Research Center - 50 North Dunlap St, Memphis, TN 38103 | 2020-04-01 |
| 1962030221 | Allison Burge Clayton | Dietitian, Registered | 50 N Dunlap, Nutrition Therapy Dept, 1st Floor Research Tower, Memphis, TN 38103 | 2020-03-31 |
| 1093375420 | Radar Ems, LLC | Social Worker | 50 S. B.b. King Blvd, Suite 350, Memphis, TN 38103 | 2019-06-18 |
| 1528529021 | Denise Andrews Matthews | Nursing Care | 342 Island Dr #105, Memphis, TN 38103 | 2019-03-27 |
| 1881160059 | Christopher Paul Hernandez | Nurse Practitioner | 877 Jeffeon Ave, Memphis, TN 38103 | 2018-10-15 |
| 1194245712 | Cameron Waters Clinard | Optometrist | 127 Isle Creek Dr, Memphis, TN 38103 | 2017-06-24 |
| 1750732582 | Amanda Leigh Eaves | Nurse Practitioner | 364 S Front St Ste 201, Memphis, TN 38103 | 2016-06-22 |
| 1417304569 | John Clark Shell | Family Medicine | 150 Harbor Creek Dr, Memphis, TN 38103 | 2016-05-18 |
| 1750753695 | Tomisha V. Byard | Nurse Practitioner | 718 Habor Bend Road, Memphis, TN 38103 | 2015-10-29 |
| 1053795179 | Melissa Anne Wilkes | Social Worker | 1240 Harbor River Drive, Memphis, TN 38103 | 2015-07-18 |
| Find all providers in zip 38103 | ||||
| Taxonomy Code | 229N00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Anaplastologist |
| An anaplastologist is a professional who creates prostheses for the face and body. Patients treated include those missing anatomy due to cancer, traumatic injury, or birth differences. Generally, there are no state licensing requirements for anaplastologists. Certification specific to anaplastology is provided through the Board for Certified Clinical Anaplastology (BCCA) with a credential title of Certified Clinical Anaplastologist (CCA). |
| Notes: Source: American Anaplastology Association, www.anaplastology.org. [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902278179 | University of Tennessee | Anaplastologist | 875 Union Ave., Rooms S510b, Memphis, TN 38163-0001 | 2015-10-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649414988 | Heather L Timbario | Anaplastologist | 8005 Church St E, Brentwood, TN 37027-5278 | 2009-04-30 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.