Healthcare Provider Details

I. General information

NPI: 1215567672
Provider Name (Legal Business Name): RITZI RX MEDICAL WIG CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 4TH ST
MERIDIAN MS
39301-5102
US

IV. Provider business mailing address

2120 4TH ST
MERIDIAN MS
39301-5102
US

V. Phone/Fax

Practice location:
  • Phone: 601-462-6480
  • Fax: 601-286-1942
Mailing address:
  • Phone: 601-462-6480
  • 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: TIFFANY ROBERTS
Title or Position: OWNER
Credential:
Phone: 601-462-6480