Healthcare Provider Details

I. General information

NPI: 1710155098
Provider Name (Legal Business Name): BARBARA'S FAMILY STYLE SALON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 EASTERN VALLEY RD
BESSEMER AL
35020-8600
US

IV. Provider business mailing address

1330 EASTERN VALLEY RD
BESSEMER AL
35020-8600
US

V. Phone/Fax

Practice location:
  • Phone: 205-424-5280
  • Fax:
Mailing address:
  • Phone: 205-424-5280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number08014392
License Number StateAL

VIII. Authorized Official

Name: MRS. BARBARA A CLINTON
Title or Position: OWNER/OPERATOR
Credential: CERTIFIED FITTER
Phone: 205-424-5280