MEDICARE: BUNDLES LUXURY HAIR CO.

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	1744P3200X	Prosthetics Case Management

General Provider Information

NPI Number	:	1043714678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUNDLES LUXURY HAIR CO.

Provider Business Mailing Address
First Line	:	4000 SIGMA RD APT 4206
Second Line	:
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75244-8119
Country	:	US
Telephone Number	:	810-275-2185
Fax Number	:

Provider Business Practice Location Address
First Line	:	13740 MIDWAY RD STE 524
Second Line	:
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75244-4314
Country	:	US
Telephone Number	:	972-286-3537
Fax Number	:

Authorized Official
Title or Position	:	HAIR RESTORATION SPECIALIST
Name	:	SHAUNTELE HARVEY
Credential	:
Telephone Number	:	810-275-2185

Provider Enumeration Date	:	03/20/2018
Last Update Date	:	03/20/2018

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