=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831976554
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FULL FIGURE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2023
-----------------------------------------------------
Last Update Date | 09/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3437 MASONIC DR STE 1126
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71301-3641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-625-7457
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 372
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71454-0372
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. TARA SAPP
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 318-332-3657
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224900000X
-----------------------------------------------------
Taxonomy Name | Mastectomy Fitter
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------