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General NPI Number Information
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NPI Number | 1710554944
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL BARBER SHOP, INC.
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Dates
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Enumeration Date | 06/07/2021
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Last Update Date | 10/09/2022
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Provider Practice Location Address
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Address Line | 811 WHITTAKER PKWY
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City | ORANGEBURG
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State | SC
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Zip | 29115-6248
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Country | US
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Telephone | 803-682-5026
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 682
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City | ORANGEBURG
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State | SC
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Zip | 29116-0682
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Country | US
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Telephone | 803-682-5027
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Fax |
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Authorized Official
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Title or Position | CRANIAL PROSTHESIS PERSONNEL
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Name | MR. PAUL E ROBINSON JR.
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Credential | CRANIAL PROSTHETICS
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Telephone | 803-682-5027
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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 |
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License Number State |
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