MEDICARE: ALBERTAS A NATURAL LOOK LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1023455433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALBERTAS A NATURAL LOOK LLC

Provider Business Mailing Address
First Line	:	6310 FAR HILLS AVE
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-2724
Country	:	US
Telephone Number	:	937-291-0010
Fax Number	:	937-291-9276

Provider Business Practice Location Address
First Line	:	6310 FAR HILLS AVE
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-2724
Country	:	US
Telephone Number	:	937-291-0010
Fax Number	:	937-291-9276

Authorized Official
Title or Position	:	OWNER
Name	:	EILEEN C TRACY
Credential	:
Telephone Number	:	937-291-0010

Provider Enumeration Date	:	05/24/2013
Last Update Date	:	05/24/2013

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