Provider Demographics
NPI:1790974384
Name:SIMPLY IRRESISTIBLE WOMAN, LLC
Entity Type:Organization
Organization Name:SIMPLY IRRESISTIBLE WOMAN, LLC
Other - Org Name:COLOR ME PINK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SINGLE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-953-1377
Mailing Address - Street 1:115 MARGIE DR STE D
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-7582
Mailing Address - Country:US
Mailing Address - Phone:478-953-1377
Mailing Address - Fax:478-971-1646
Practice Address - Street 1:115 MARGIE DR STE D
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-7582
Practice Address - Country:US
Practice Address - Phone:478-953-1377
Practice Address - Fax:478-971-1646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6029780001OtherPROVIDER TRANSACTION ACCESS NUMBER
GA6029780001Medicare NSC