Provider Demographics
NPI:1427186436
Name:LEGORAS CONTURE FASHIONS
Entity Type:Organization
Organization Name:LEGORAS CONTURE FASHIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LEGORA
Authorized Official - Middle Name:ALVERTA
Authorized Official - Last Name:MARKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-483-1614
Mailing Address - Street 1:3316 INWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815
Mailing Address - Country:US
Mailing Address - Phone:260-483-1614
Mailing Address - Fax:260-471-7374
Practice Address - Street 1:3316 INWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815
Practice Address - Country:US
Practice Address - Phone:260-483-1614
Practice Address - Fax:260-471-7374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28226285OtherRN
IN100181100AMedicaid
0294630001Medicare ID - Type Unspecified