MEDICARE: CASSI WIGINGTON

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	:	1528216900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASSI WIGINGTON

Provider Business Mailing Address
First Line	:	11042 SAHLER ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68164-2317
Country	:	US
Telephone Number	:	402-699-1172
Fax Number	:

Provider Business Practice Location Address
First Line	:	13057 W CENTER RD
Second Line	:	SUITE 25
City	:	OMAHA
State	:	NE
Zip	:	68144-3748
Country	:	US
Telephone Number	:	402-333-7502
Fax Number	:	402-333-7504

Authorized Official
Title or Position	:	CERTIFIED FITTER OF MASTECTOMY
Name	:	MRS. CASSI CORINN WIGINGTON
Credential	:	CFM
Telephone Number	:	402-333-7502

Provider Enumeration Date	:	08/28/2008
Last Update Date	:	11/24/2008

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Directions to “CASSI WIGINGTON ” Practice Location

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