Provider Demographics
NPI:1477199883
Name:FOUR SISTERS LLC
Entity Type:Organization
Organization Name:FOUR SISTERS LLC
Other - Org Name:FOUNDATIONS PROFESSIONAL BRA FITTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGOS
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:228-424-1913
Mailing Address - Street 1:9138 CARL LEGETT RD STE C
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-6262
Mailing Address - Country:US
Mailing Address - Phone:228-896-3688
Mailing Address - Fax:228-896-3688
Practice Address - Street 1:9138 CARL LEGETT RD STE C
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-6262
Practice Address - Country:US
Practice Address - Phone:228-896-3688
Practice Address - Fax:228-896-3688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-20
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies