Provider Demographics
NPI:1528216900
Name:CASSI WIGINGTON
Entity Type:Organization
Organization Name:CASSI WIGINGTON
Other - Org Name:NEW IMAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CERTIFIED FITTER OF MASTECTOMY
Authorized Official - Prefix:MRS
Authorized Official - First Name:CASSI
Authorized Official - Middle Name:CORINN
Authorized Official - Last Name:WIGINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:402-333-7502
Mailing Address - Street 1:11042 SAHLER ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-2317
Mailing Address - Country:US
Mailing Address - Phone:402-699-1172
Mailing Address - Fax:
Practice Address - Street 1:13057 W CENTER RD
Practice Address - Street 2:SUITE 25
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3748
Practice Address - Country:US
Practice Address - Phone:402-333-7502
Practice Address - Fax:402-333-7504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE6137300001Medicare NSC