A Special Place Wig Boutique, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

100033237 Issued in VA

Legal business name

A SPECIAL PLACE WIG BOUTIQUE, LLC

Practice address

5524 Williamson Rd
Suite 6
Roanoke, VA 24012-1448

Phone

(540) 265-2960

Fax

(540) 265-2970

NPI assigned

Apr 28, 2016

Organization subpart

Yes

Parent organization

A SPECIAL PLACE WIG GALLERYAs reported in NPPES

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

Authorized official

Name

Mrs. Jamela A Hodgson

Title

Owner

Phone

(336) 574-0100

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• A Special Place Other name

Part of

Jamela Hodgson

Locations

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

{
    "created_epoch": "1461801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461801600000",
    "number": "1013362896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5524 WILLIAMSON RD",
            "address_2": "SUITE 6",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240121448",
            "telephone_number": "540-265-2960",
            "fax_number": "540-265-2970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5524 WILLIAMSON RD",
            "address_2": "SUITE 6",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240121448",
            "telephone_number": "540-265-2960",
            "fax_number": "540-265-2970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A SPECIAL PLACE WIG BOUTIQUE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "A SPECIAL PLACE WIG GALLERY",
        "enumeration_date": "2016-04-28",
        "last_updated": "2016-04-28",
        "status": "A",
        "authorized_official_last_name": "HODGSON",
        "authorized_official_first_name": "JAMELA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-574-0100",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "VA",
            "license": "100033237",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF NORTH CAROLINA",
            "identifier": "1629029848",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "A Special Place",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• All providers in Roanoke, VA
• Durable Medical Equipment & Medical Supplies in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2016; 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.