Provider Demographics
NPI:1700420742
Name:INKCREDIBLE TATTOO FACTORY
Entity Type:Organization
Organization Name:INKCREDIBLE TATTOO FACTORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL TATTOO TECH./OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-205-7187
Mailing Address - Street 1:125 JOSEPH RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-5903
Mailing Address - Country:US
Mailing Address - Phone:717-205-7187
Mailing Address - Fax:
Practice Address - Street 1:40 S MARKET ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-2307
Practice Address - Country:US
Practice Address - Phone:717-205-7187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INKCREDIBLE TATTOO FACTORY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-02
Last Update Date:2019-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center