Provider Demographics
NPI:1639300254
Name:THE WIG SHOPPE
Entity Type:Organization
Organization Name:THE WIG SHOPPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMBARIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-891-1417
Mailing Address - Street 1:8005 CHURCH ST E
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5278
Mailing Address - Country:US
Mailing Address - Phone:615-891-1417
Mailing Address - Fax:615-891-1418
Practice Address - Street 1:8005 CHURCH ST E
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5278
Practice Address - Country:US
Practice Address - Phone:615-891-1417
Practice Address - Fax:615-891-1418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier