Provider Demographics
NPI:1710155098
Name:BARBARA'S FAMILY STYLE SALON
Entity Type:Organization
Organization Name:BARBARA'S FAMILY STYLE SALON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED FITTER
Authorized Official - Phone:205-424-5280
Mailing Address - Street 1:1330 EASTERN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35020-8600
Mailing Address - Country:US
Mailing Address - Phone:205-424-5280
Mailing Address - Fax:
Practice Address - Street 1:1330 EASTERN VALLEY RD
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35020-8600
Practice Address - Country:US
Practice Address - Phone:205-424-5280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL08014392335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-57240OtherBLUE CROSS/BLUE SHIELD
AL510-57240OtherBLUE CROSS/BLUE SHIELD