MEDICARE: EXTENSIONS & HAIR BOUDOIR

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	:	1578424461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXTENSIONS & HAIR BOUDOIR

Provider Business Mailing Address
First Line	:	7705 SAINT ANDREWS RD BLDG B
Second Line	:
City	:	IRMO
State	:	SC
Zip	:	29063-2835
Country	:	US
Telephone Number	:	803-445-6931
Fax Number	:

Provider Business Practice Location Address
First Line	:	7705 SAINT ANDREWS RD BLDG B
Second Line	:
City	:	IRMO
State	:	SC
Zip	:	29063-2835
Country	:	US
Telephone Number	:	803-445-6931
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ERICA WIGGINS
Credential	:
Telephone Number	:	803-445-6931

Provider Enumeration Date	:	11/20/2025
Last Update Date	:	11/20/2025

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Directions to “EXTENSIONS & HAIR BOUDOIR ” Practice Location

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