Provider Demographics
NPI:1659080448
Name:BOSSART HAIR LLC
Entity Type:Organization
Organization Name:BOSSART HAIR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON-BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-523-9033
Mailing Address - Street 1:9949 E INDEPENDENCE BLVD # 19
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-4665
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9949 E INDEPENDENCE BLVD # 19
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-4665
Practice Address - Country:US
Practice Address - Phone:317-721-5030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies