MEDICARE: MINKS GLAMOUR STUDIO

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1639929532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINKS GLAMOUR STUDIO

Provider Business Mailing Address
First Line	:	9008 OLD CLYDESDALE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-3546
Country	:	US
Telephone Number	:	817-908-2740
Fax Number	:

Provider Business Practice Location Address
First Line	:	5260 S HULEN ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-1912
Country	:	US
Telephone Number	:	817-908-2740
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MIESHA KEATON
Credential	:
Telephone Number	:	817-908-2740

Provider Enumeration Date	:	03/25/2024
Last Update Date	:	03/25/2024

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Directions to “MINKS GLAMOUR STUDIO ” Practice Location

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