Provider Demographics
NPI:1326370990
Name:THAT CERTAIN LOOK, INC.
Entity Type:Organization
Organization Name:THAT CERTAIN LOOK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:501-729-5490
Mailing Address - Street 1:P.O. BOX 297
Mailing Address - Street 2:300 VAN BUREN ST.
Mailing Address - City:JUDSONIA
Mailing Address - State:AR
Mailing Address - Zip Code:72081
Mailing Address - Country:US
Mailing Address - Phone:501-729-5490
Mailing Address - Fax:501-729-1511
Practice Address - Street 1:300 VAN BUREN ST.
Practice Address - Street 2:
Practice Address - City:JUDSONIA
Practice Address - State:AR
Practice Address - Zip Code:72081
Practice Address - Country:US
Practice Address - Phone:501-729-5490
Practice Address - Fax:501-729-1511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR6379860001Medicare NSC