Provider Demographics
NPI:1881305167
Name:BLIP BEAUTY LLC
Entity type:Organization
Organization Name:BLIP BEAUTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIA
Authorized Official - Middle Name:JAVONNE
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-328-3177
Mailing Address - Street 1:9550 S MASON MONTGOMERY RD # 1040
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-9759
Mailing Address - Country:US
Mailing Address - Phone:513-250-2260
Mailing Address - Fax:
Practice Address - Street 1:967 HAVENSPORT DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-1853
Practice Address - Country:US
Practice Address - Phone:513-328-3177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier