Magique Boutique LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

MAGIQUE BOUTIQUE LLC

Practice address

760 Whalers Way Ste C120
Fort Collins, CO 80525-3372

Phone

(970) 230-5780

Fax

(970) 236-2596

NPI assigned

Jul 26, 2024

Organization subpart

No

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

Authorized official

Name

Jane Mardis

Title

President

Phone

(970) 230-5780

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1721952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721952000000",
    "number": "1144059437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "760 WHALERS WAY STE C120",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805253372",
            "telephone_number": "970-230-5780",
            "fax_number": "970-236-2596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "760 WHALERS WAY STE C120",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805253372",
            "telephone_number": "970-230-5780",
            "fax_number": "970-236-2596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGIQUE BOUTIQUE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-26",
        "last_updated": "2024-07-26",
        "certification_date": "2024-07-26",
        "status": "A",
        "authorized_official_last_name": "MARDIS",
        "authorized_official_first_name": "JANE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "970-230-5780"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Rebecca Maestas, PHARM D.
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• Scott Magnus, RN
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• Elizabeth Glenn Magoto, LPN
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• Durable Medical Equipment & Medical Supplies in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Durable Medical Equipment & Medical Supplies in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.