Provider Demographics
NPI:1275674525
Name:ANNETTES POST MASTECTOMY SHOP
Entity Type:Organization
Organization Name:ANNETTES POST MASTECTOMY SHOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BABER-SURRETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-697-0302
Mailing Address - Street 1:615 GREENVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-5393
Mailing Address - Country:US
Mailing Address - Phone:828-697-0302
Mailing Address - Fax:828-697-6915
Practice Address - Street 1:615 GREENVILLE HWY
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-5393
Practice Address - Country:US
Practice Address - Phone:828-697-0302
Practice Address - Fax:828-697-6915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5473850001Medicare ID - Type Unspecified