MEDICARE: WHBOUTIQUE INC.

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	1000223	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	533245	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396078507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHBOUTIQUE INC.

Provider Business Mailing Address
First Line	:	605 N 6TH ST
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75601-6606
Country	:	US
Telephone Number	:	903-758-9904
Fax Number	:	903-236-9786

Provider Business Practice Location Address
First Line	:	8499 GREENVILLE AVE STE 105
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-2417
Country	:	US
Telephone Number	:	214-373-1045
Fax Number	:	214-221-9282

Authorized Official
Title or Position	:	OWNER
Name	:	VICKI D JONES
Credential	:
Telephone Number	:	214-373-1045

Provider Enumeration Date	:	09/08/2009
Last Update Date	:	03/23/2020

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Directions to “WHBOUTIQUE INC. ” Practice Location

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