MEDICARE: ELITE HAIR STRANDS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	335E00000X	Prosthetic/Orthotic Supplier
3	332BC3200X	Customized Equipment (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	320729774481	OTHER	TX	TAX ID

General Provider Information

NPI Number	:	1356971733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE HAIR STRANDS LLC

Provider Business Mailing Address
First Line	:	4609 MARKS IV PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76161
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4609 MARKS IV PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76161
Country	:	US
Telephone Number	:	682-465-5231
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JEANELLE BRINKLEY
Credential	:
Telephone Number	:	682-465-5231

Provider Enumeration Date	:	01/24/2020
Last Update Date	:	01/24/2020

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Directions to “ELITE HAIR STRANDS LLC ” Practice Location

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