Provider Demographics
NPI:1598259954
Name:NATURAL WIGS STORE
Entity Type:Organization
Organization Name:NATURAL WIGS STORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-772-1600
Mailing Address - Street 1:1722 BROAD RIVER RD STE C
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-7336
Mailing Address - Country:US
Mailing Address - Phone:803-772-1600
Mailing Address - Fax:859-681-1306
Practice Address - Street 1:1722 BROAD RIVER RD STE C
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-7336
Practice Address - Country:US
Practice Address - Phone:803-772-1600
Practice Address - Fax:859-681-1306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-19
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier