Healthcare Provider Details

I. General information

NPI: 1700572153
Provider Name (Legal Business Name): WIGSLAYERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 S 90TH DR
TOLLESON AZ
85353-6928
US

IV. Provider business mailing address

PO BOX 511
TOLLESON AZ
85353-0511
US

V. Phone/Fax

Practice location:
  • Phone: 480-356-2118
  • Fax:
Mailing address:
  • Phone: 480-356-2118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: SHALALAH N SAUNDERS
Title or Position: CEO
Credential:
Phone: 480-356-2118