Provider Demographics
NPI:1649683145
Name:T. ANDERSON WIGS
Entity type:Organization
Organization Name:T. ANDERSON WIGS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COSMETOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TAMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-637-2475
Mailing Address - Street 1:PO BOX 8735
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68108-0735
Mailing Address - Country:US
Mailing Address - Phone:402-637-2475
Mailing Address - Fax:
Practice Address - Street 1:5421 N 103RD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-1000
Practice Address - Country:US
Practice Address - Phone:402-637-2475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE48699282N00000X, 305R00000X, 283X00000X, 281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital
No282N00000XHospitalsGeneral Acute Care Hospital
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No283X00000XHospitalsRehabilitation Hospital