Mastec Womens Boutique

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

MASTEC WOMENS BOUTIQUE

Practice address

524 E Milham Ave
Portage, MI 49002-1473

Phone

(269) 373-6223

Fax

(269) 373-6223

NPI assigned

Dec 18, 2006

Last updated

Oct 19, 2016By 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

Virgie Ammerman

Title

Ceo/President

Phone

(269) 598-7765

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476835200000",
    "number": "1194888628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "524 E MILHAM AVE",
            "address_2": "SUITE B",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "49002",
            "telephone_number": "269-373-6223",
            "fax_number": "269-373-4720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "524 E MILHAM AVE",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490021473",
            "telephone_number": "269-373-6223",
            "fax_number": "269-373-6223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASTEC WOMENS BOUTIQUE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2016-10-19",
        "status": "A",
        "authorized_official_last_name": "AMMERMAN",
        "authorized_official_first_name": "VIRGIE",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "269-598-7765"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "540C903700",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kenneth Blair Martin Jr., LMSW
• Brandon Martinez-Onstott, BCBA
• Christian Martinez
• Michael Thomas Martini, DC
• Michael P Maskill, DPM
• Paul Richard Maston, DDS
• Philip Alexander Mataverde, D.O.
• Maternal Hope Counseling Center
• Jenna Mathis, LMSW
• Lauren Matte

• Durable Medical Equipment & Medical Supplies in Portage, MI
• Providers in Portage, MI by specialty
• Durable Medical Equipment & Medical Supplies in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 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.