Provider Demographics
NPI:1083197487
Name:JAZZBEUTYBAR LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:JAZZBEUTYBAR LIMITED LIABILITY COMPANY
Other - Org Name:JAZZBEAUTYBAR LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED STYLIST
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-603-6627
Mailing Address - Street 1:5150 JACK BYRNES DR APT 3202
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-7057
Mailing Address - Country:US
Mailing Address - Phone:615-603-6627
Mailing Address - Fax:
Practice Address - Street 1:231 VETERANS PKWY STE C.1
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-6437
Practice Address - Country:US
Practice Address - Phone:615-603-6627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-11
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1083197487Medicaid