MEDICARE: ART-CUT-TECTS BARBERSHOP & SUPPLIES LLC

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	305S00000X	Point of Service

General Provider Information

NPI Number	:	1881320737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ART-CUT-TECTS BARBERSHOP & SUPPLIES LLC

Provider Business Mailing Address
First Line	:	2843 E STATE BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-4732
Country	:	US
Telephone Number	:	260-750-2889
Fax Number	:

Provider Business Practice Location Address
First Line	:	2843 E STATE BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-4732
Country	:	US
Telephone Number	:	260-750-2889
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JUAN DEON WILLIAMS
Credential	:
Telephone Number	:	260-418-6528

Provider Enumeration Date	:	07/25/2022
Last Update Date	:	07/25/2022

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