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General NPI Number Information
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NPI Number | 1528764784
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Entity Type | Organization
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Legal Business Name | STAGE 1 HAIR LOSS REPLACEMENT & SALON
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Dates
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Enumeration Date | 01/31/2023
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 216 MAIN STREET
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City | MEADVILLE
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State | MS
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Zip | 39653
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Country | US
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Telephone | 601-384-4532
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Fax | 601-384-8334
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Provider Business Mailing Address
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Address Line | PO BOX 240
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City | MEADVILLE
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State | MS
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Zip | 39653-0240
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Country | US
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Telephone | 601-384-4532
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Fax | 601-384-4532
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Authorized Official
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Title or Position | PROVIDER
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Name | MRS. ALANDA K TILLMAN
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Credential |
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Telephone | 601-384-4532
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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