MEDICARE: PERFERT CHOICE MEDICAL WIGS

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

General Provider Information

NPI Number	:	1457045874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERFERT CHOICE MEDICAL WIGS

Provider Business Mailing Address
First Line	:	1646 HIGHWAY 160 W STE 105
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-8010
Country	:	US
Telephone Number	:	803-577-3671
Fax Number	:

Provider Business Practice Location Address
First Line	:	1749 GREAT FALLS RD
Second Line	:
City	:	LANCASTER
State	:	SC
Zip	:	29720-0234
Country	:	US
Telephone Number	:	803-577-3671
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROQUAWNA CATOE
Credential	:
Telephone Number	:	803-577-3671

Provider Enumeration Date	:	06/07/2023
Last Update Date	:	06/19/2023

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