A Wig Boutique Etc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

660943 Issued in FL

Legal business name

A WIG BOUTIQUE ETC.

Practice address

6707 Plantation Rd
Suite C3
Pensacola, FL 32504-6214

Phone

(850) 476-1916

Fax

(850) 476-1916

NPI assigned

Jan 19, 2010

Last updated

Jan 19, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michelle BlakeneyNPI 1972456887

Title

Owner/Operator

Phone

(850) 476-1916

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michelle L Blakeney

  • Prosthetic/Orthotic Supplier
  • Pensacola, FL
  • NPI 1972456887
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1263859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263859200000",
    "number": "1013248806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6707 PLANTATION RD",
            "address_2": "SUITE C3",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325046214",
            "telephone_number": "850-476-1916",
            "fax_number": "850-476-1916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6707 PLANTATION RD",
            "address_2": "SUITE C3",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325046214",
            "telephone_number": "850-476-1916",
            "fax_number": "850-476-1916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A WIG BOUTIQUE ETC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-19",
        "last_updated": "2010-01-19",
        "status": "A",
        "authorized_official_last_name": "BLAKENEY",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "850-476-1916"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "FL",
            "license": "660943",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Pensacola, FL
• Providers in Pensacola, FL by specialty
• Durable Medical Equipment & Medical Supplies in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.