MEDICARE: HAIR SPECIALTY SUPPLY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier	1011437	TX

General Provider Information

NPI Number	:	1366625790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAIR SPECIALTY SUPPLY

Provider Business Mailing Address
First Line	:	5707 CIBOLO CANYON BLVD
Second Line	:	1617
City	:	SAN ANTONIO
State	:	TX
Zip	:	78261-2773
Country	:	US
Telephone Number	:	210-367-3800
Fax Number	:

Provider Business Practice Location Address
First Line	:	5707 CIBOLO CANYON BLVD
Second Line	:	1617
City	:	SAN ANTONIO
State	:	TX
Zip	:	78261-2773
Country	:	US
Telephone Number	:	210-367-3800
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MISS LELA Z HAMILTON
Credential	:
Telephone Number	:	210-367-3800

Provider Enumeration Date	:	12/07/2007
Last Update Date	:	07/04/2008

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Directions to “HAIR SPECIALTY SUPPLY ” Practice Location

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