Provider Demographics
NPI:1053358267
Name:HIGH PLAINS PLASTIC AND RECONSTRUCTIVE SURGERY
Entity type:Organization
Organization Name:HIGH PLAINS PLASTIC AND RECONSTRUCTIVE SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-242-2001
Mailing Address - Street 1:3501 S SONCY RD
Mailing Address - Street 2:1001
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6407
Mailing Address - Country:US
Mailing Address - Phone:806-242-2001
Mailing Address - Fax:806-322-2015
Practice Address - Street 1:3501 S SONCY RD
Practice Address - Street 2:1001
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6407
Practice Address - Country:US
Practice Address - Phone:806-242-2001
Practice Address - Fax:806-322-2015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0019KDOtherBCBS OF TEXAS
TXH27118Medicare UPIN
TX00688VMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER