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General NPI Number Information
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NPI Number | 1699974188
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Entity Type | Organization
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Legal Business Name | BEAUTY IMAGE CENTER
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 07/13/2007
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Provider Practice Location Address
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Address Line | 1280 BAMBERG CT
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City | HANOVER PARK
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State | IL
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Zip | 60103
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Country | US
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Telephone | 630-483-9225
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Fax | 630-483-1958
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Provider Business Mailing Address
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Address Line | 1280 BAMBERG CT
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City | HANOVER PARK
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State | IL
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Zip | 60103
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Country | US
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Telephone | 630-483-9225
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Fax | 630-483-1958
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Authorized Official
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Title or Position | BILLING COORDINATOR
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Name | FAITH C. M. MCNICHOLAS
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Credential | CPC
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Telephone | 847-965-8552
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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 | 11227254
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License Number State | IL
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