Provider Demographics
NPI:1114386117
Name:WIGS PLUS LLC
Entity Type:Organization
Organization Name:WIGS PLUS LLC
Other - Org Name:WIGS PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-549-4111
Mailing Address - Street 1:3509 CONNECTICUT AVE NW
Mailing Address - Street 2:STE 191
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-2400
Mailing Address - Country:US
Mailing Address - Phone:202-549-4111
Mailing Address - Fax:202-478-5130
Practice Address - Street 1:1728 CONNECTICUT AVE NW
Practice Address - Street 2:STE 3A
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-1220
Practice Address - Country:US
Practice Address - Phone:202-803-2752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier