=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689317117
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BYRONRENARD'S HAIR DESIGNS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2022
-----------------------------------------------------
Last Update Date | 04/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 926 STUDER AVE
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43206-1635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-808-5471
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 926 STUDER AVE
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43206-1635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-808-5471
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | BYRON R WOODS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 614-808-5471
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 342000000X
-----------------------------------------------------
Taxonomy Name | Transportation Network Company
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------