Provider Demographics
NPI:1518587914
Name:BMB MEDICAL BEAUTIQUE
Entity Type:Organization
Organization Name:BMB MEDICAL BEAUTIQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-321-5794
Mailing Address - Street 1:6515 GOODMAN RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-7333
Mailing Address - Country:US
Mailing Address - Phone:912-321-5794
Mailing Address - Fax:662-262-5805
Practice Address - Street 1:6515 GOODMAN RD STE 300
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-7333
Practice Address - Country:US
Practice Address - Phone:912-321-5794
Practice Address - Fax:662-262-5805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-26
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier