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General NPI Number Information
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NPI Number | 1033219175
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Entity Type | Organization
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Legal Business Name | PETTICOAT FAIR INC
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 7739 NORTHCROSS DR SUITE M
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City | AUSTIN
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State | TX
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Zip | 78757-1700
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Country | US
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Telephone | 512-454-2900
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Fax | 512-454-3381
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Provider Business Mailing Address
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Address Line | PO BOX 10676
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City | AUSTIN
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State | TX
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Zip | 78766-1676
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Country | US
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Telephone | 512-454-2900
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Fax | 512-454-3381
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KIRK ANDREWS
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Credential |
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Telephone | 512-454-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 17
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License Number State | TX
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