Provider Demographics
NPI:1689737413
Name:FREEDOM2GO, LLC
Entity Type:Organization
Organization Name:FREEDOM2GO, LLC
Other - Org Name:NEW IMPRESSIONS BOUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-437-2382
Mailing Address - Street 1:PO BOX 2802
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79604-2802
Mailing Address - Country:US
Mailing Address - Phone:325-437-3315
Mailing Address - Fax:325-437-5497
Practice Address - Street 1:3303 N 3RD ST
Practice Address - Street 2:SUITE J
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79603-7097
Practice Address - Country:US
Practice Address - Phone:325-437-3315
Practice Address - Fax:325-437-5497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0093173332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1268500007Medicare NSC