Provider Demographics
NPI:1245407998
Name:MABELINE INC.
Entity Type:Organization
Organization Name:MABELINE INC.
Other - Org Name:MABELINE WIG COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:319-363-3391
Mailing Address - Street 1:3136 MOUNT VERNON RD SE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-3655
Mailing Address - Country:US
Mailing Address - Phone:319-363-3391
Mailing Address - Fax:319-364-8610
Practice Address - Street 1:3136 MOUNT VERNON RD SE
Practice Address - Street 2:SUITE B
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-3655
Practice Address - Country:US
Practice Address - Phone:319-363-3391
Practice Address - Fax:319-364-8610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1-57-016146332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA18351OtherWELLMARK BLUE CROSS BLUE SHIELD