Provider Demographics
NPI:1467607606
Name:MCGLOTHLIN WIG COMPANY
Entity Type:Organization
Organization Name:MCGLOTHLIN WIG COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCGLOTHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-669-1650
Mailing Address - Street 1:525 STATE ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-4314
Mailing Address - Country:US
Mailing Address - Phone:276-669-1650
Mailing Address - Fax:276-466-1787
Practice Address - Street 1:525 STATE ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-4314
Practice Address - Country:US
Practice Address - Phone:276-669-1650
Practice Address - Fax:276-466-1787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier