Provider Demographics
NPI:1710554944
Name:PROFESSIONAL BARBER SHOP, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL BARBER SHOP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRANIAL PROSTHESIS PERSONNEL
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:CRANIAL PROSTHETICS
Authorized Official - Phone:803-682-5027
Mailing Address - Street 1:PO BOX 682
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29116-0682
Mailing Address - Country:US
Mailing Address - Phone:803-682-5027
Mailing Address - Fax:
Practice Address - Street 1:811 WHITTAKER PKWY
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-6248
Practice Address - Country:US
Practice Address - Phone:803-682-5026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2022-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty