Provider Demographics
NPI:1437295466
Name:BEAUTY PLUS WIGS HATS & LINGERIE, INC.
Entity Type:Organization
Organization Name:BEAUTY PLUS WIGS HATS & LINGERIE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-755-7500
Mailing Address - Street 1:3633 CORTEZ RD W STE B11
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3149
Mailing Address - Country:US
Mailing Address - Phone:941-755-7500
Mailing Address - Fax:941-755-9990
Practice Address - Street 1:3633 CORTEZ RD W STE B11
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3149
Practice Address - Country:US
Practice Address - Phone:941-755-7500
Practice Address - Fax:941-755-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL51803498681332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5530980001Medicare NSC
FL5530980001Medicaid