FLEMING ISLAND PLASTIC SURGERY LLC
NPI 1245602069
Surgery - Plastic and Reconstructive Surgery in Fleming Island, FL
NPI Status: Active since October 21, 2015
Contact Information
1715 EAGLE HARBOR PKWY STE B
FLEMING ISLAND, FL
ZIP 32003
Phone: (904) 990-3477
Fax: (904) 621-9272
- Organization
- Surgery
- Plastic and Reconstructive Surgery
- CLIA Number: 10D2138179
- CLIA Cert. Type: End Stage Renal Disease Dialysis Facility
- CLIA Exp. Date: 10-11-2027
About FLEMING ISLAND PLASTIC SURGERY LLC
This page provides the complete NPI Profile along with additional information for Fleming Island Plastic Surgery Llc, a provider established in Fleming Island, Florida operating as a Surgery, focusing in plastic and reconstructive surgery . The healthcare provider is registered in the NPI registry with number 1245602069 assigned on October 2015. The practitioner's primary taxonomy code is 2086S0122X with license number ME107749 (FL). The provider is registered as an organization and their NPI record was last updated 2 years ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The authorized official of this NPI record is Dr. William Wallace Md (Manager/owner)
- NPI
- 1245602069
- Provider Name
- FLEMING ISLAND PLASTIC SURGERY LLC
- Entity Type
- Organization
- Location Address
- 1715 EAGLE HARBOR PKWY STE B FLEMING ISLAND, FL 32003
- Location Phone
- (904) 990-3477
- Location Fax
- (904) 621-9272
- Mailing Address
- 916 ALAMEDA LN SAINT JOHNS, FL 32259
- Mailing Phone
- (904) 348-0727
- Mailing Fax
- (904) 621-9272
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 10-21-2015
- Last Update Date
- 09-13-2024
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Surgery Plastic and Reconstructive Surgery
- Taxonomy Code
- 2086S0122X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- ME107749
- License State
- FL
- Taxonomy Description
- A surgeon who specializes in plastic and reconstructive surgery.
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 10D2138179
- Facility Type
- End Stage Renal Disease Dialysis Facility
- Certificate Effective Date
- October 12, 2025
- Certificate Expiration Date
- October 11, 2027
- Laboratory Director
- RAMA T. REDDY
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Fleming Island Plastic Surgery Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1245602069, we treat the final digit (9) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 51. The final step is to find the difference between that total and the next multiple of ten (60 - 51 = 9).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 51 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1245602069, enumerated as an "organization" on October 21, 2015.
The provider is located at 1715 EAGLE HARBOR PKWY STE B FLEMING ISLAND, FL 32003 and the phone number is (904) 990-3477.
Surgery with taxonomy code 2086S0122X and a focus in Plastic and Reconstructive Surgery.
