Provider Demographics
NPI:1457045874
Name:PERFERT CHOICE MEDICAL WIGS
Entity Type:Organization
Organization Name:PERFERT CHOICE MEDICAL WIGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROQUAWNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CATOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-577-3671
Mailing Address - Street 1:1646 HIGHWAY 160 W STE 105
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8010
Mailing Address - Country:US
Mailing Address - Phone:803-577-3671
Mailing Address - Fax:
Practice Address - Street 1:1749 GREAT FALLS RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-0234
Practice Address - Country:US
Practice Address - Phone:803-577-3671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-07
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier