Provider Demographics
NPI:1962010645
Name:HAIR & SCALP RESTORATION CENTER
Entity Type:Organization
Organization Name:HAIR & SCALP RESTORATION CENTER
Other - Org Name:HAIR & SCALP RESTORATION CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEKO
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-590-6605
Mailing Address - Street 1:726 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:YAZOO CITY
Mailing Address - State:MS
Mailing Address - Zip Code:39194-3483
Mailing Address - Country:US
Mailing Address - Phone:662-590-6605
Mailing Address - Fax:769-022-5992
Practice Address - Street 1:246 BRIARWOOD DR STE 102
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-3027
Practice Address - Country:US
Practice Address - Phone:662-590-6605
Practice Address - Fax:769-922-5992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-17
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier