Provider Demographics
NPI:1740019553
Name:MEDICAL WIGS FROM SCRATCH
Entity type:Organization
Organization Name:MEDICAL WIGS FROM SCRATCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AKEIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-757-1914
Mailing Address - Street 1:215 EXECUTIVE WAY STE 140
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2396
Mailing Address - Country:US
Mailing Address - Phone:214-757-1914
Mailing Address - Fax:
Practice Address - Street 1:215 EXECUTIVE WAY STE 140
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2396
Practice Address - Country:US
Practice Address - Phone:214-757-1914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment