Provider Demographics
NPI:1578834925
Name:VOGA WIGS & HAIR ADDS, LLC
Entity Type:Organization
Organization Name:VOGA WIGS & HAIR ADDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:MARLIN
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-884-8642
Mailing Address - Street 1:904 S MILITARY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-2115
Mailing Address - Country:US
Mailing Address - Phone:920-884-8642
Mailing Address - Fax:920-884-9447
Practice Address - Street 1:904 S MILITARY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-2115
Practice Address - Country:US
Practice Address - Phone:920-884-8642
Practice Address - Fax:920-884-9447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies