Provider Demographics
NPI:1689229593
Name:HAIR RESTORATION CENTER OF ROANOKE
Entity Type:Organization
Organization Name:HAIR RESTORATION CENTER OF ROANOKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HAIR RESTORATION SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHEPPERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-819-9028
Mailing Address - Street 1:3629 FRANKLIN RD SW STE 211
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-2217
Mailing Address - Country:US
Mailing Address - Phone:540-342-4000
Mailing Address - Fax:
Practice Address - Street 1:3629 FRANKLIN RD SW STE 211
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-2217
Practice Address - Country:US
Practice Address - Phone:540-342-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHEPPERD HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies