Provider Demographics
NPI:1023040532
Name:KAREN'S WIG SHOPPES, LLC
Entity Type:Organization
Organization Name:KAREN'S WIG SHOPPES, LLC
Other - Org Name:OCTOBER MORNING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:PEARL
Authorized Official - Last Name:HITCHCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-569-8988
Mailing Address - Street 1:1048 N PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:TX
Mailing Address - Zip Code:75773-1838
Mailing Address - Country:US
Mailing Address - Phone:903-569-8988
Mailing Address - Fax:903-569-2992
Practice Address - Street 1:1048 N PACIFIC ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:TX
Practice Address - Zip Code:75773-1030
Practice Address - Country:US
Practice Address - Phone:903-569-8988
Practice Address - Fax:903-569-2992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5675310001Medicare ID - Type Unspecified