Provider Demographics
NPI:1720059538
Name:HAIR CARE ON FIFTH INC
Entity Type:Organization
Organization Name:HAIR CARE ON FIFTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-382-6633
Mailing Address - Street 1:1103 5TH ST
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:IA
Mailing Address - Zip Code:50201-1816
Mailing Address - Country:US
Mailing Address - Phone:515-382-6633
Mailing Address - Fax:515-382-8084
Practice Address - Street 1:1103 5TH ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:IA
Practice Address - Zip Code:50201-1816
Practice Address - Country:US
Practice Address - Phone:515-382-6633
Practice Address - Fax:515-382-8084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F247674OtherMIDLAND CHOICE
IA0234914Medicaid
055629OtherHEALTH ALLIANCE
52744OtherBLUE CROSS BLUE SHIELD
IA0234914Medicaid