Provider Demographics
NPI:1821033267
Name:MARGRET'S MASTECTOMY SHOPPE, LTD.
Entity Type:Organization
Organization Name:MARGRET'S MASTECTOMY SHOPPE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:CIANCIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-518-3703
Mailing Address - Street 1:PO BOX 805
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-0805
Mailing Address - Country:US
Mailing Address - Phone:330-518-3703
Mailing Address - Fax:
Practice Address - Street 1:95 ARCH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1437
Practice Address - Country:US
Practice Address - Phone:330-761-2700
Practice Address - Fax:330-761-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2062422Medicaid
OH5473490001Medicare ID - Type UnspecifiedMASTECTOMY PRODUCTS