MEDICARE: INFINITE BEAUTY

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	101YP2500X	Professional Counselor
2	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1932810157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFINITE BEAUTY

Provider Business Mailing Address
First Line	:	5620 HIGHWAY 21
Second Line	:
City	:	CARSON
State	:	ND
Zip	:	58529-9746
Country	:	US
Telephone Number	:	605-490-8852
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 N. MAIN ST
Second Line	:
City	:	CARSON
State	:	ND
Zip	:	58529
Country	:	US
Telephone Number	:	605-490-8852
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MR. JOE B FORD JR.
Credential	:
Telephone Number	:	605-490-8852

Provider Enumeration Date	:	12/08/2022
Last Update Date	:	12/08/2022

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Directions to “INFINITE BEAUTY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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