MEDICARE: LUXURY LOCS

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	:	1982225850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUXURY LOCS

Provider Business Mailing Address
First Line	:	4401 W 4TH ST STE D
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39402-1006
Country	:	US
Telephone Number	:	662-322-3334
Fax Number	:	601-557-4329

Provider Business Practice Location Address
First Line	:	4401 W 4TH ST STE D
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39402-1006
Country	:	US
Telephone Number	:	662-322-3334
Fax Number	:	601-557-4329

Authorized Official
Title or Position	:	OWNER
Name	:	WHITNEY TRIMBLE
Credential	:
Telephone Number	:	662-322-3334

Provider Enumeration Date	:	05/02/2020
Last Update Date	:	05/02/2020

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Directions to “LUXURY LOCS ” Practice Location

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