Pansy'S Post Mastectomy Boutique, Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

000484 Issued in GA

Legal business name

PANSY'S POST MASTECTOMY BOUTIQUE, INC.

Practice address

100 Redmond Rd NW
Rome, GA 30165-1536

Phone

(706) 232-6600

Fax

(706) 232-6677

NPI assigned

Nov 1, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Kenneth David GoeweyNPI 1972562775

Title

Billing Manager

Phone

(706) 232-6600

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

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

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kenneth Goewey

  • Prosthetics Case Management
  • Rome, GA
  • NPI 1972562775
  NPD Authorized official

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

{
    "created_epoch": "1193875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410480000000",
    "number": "1194904540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 REDMOND RD NW",
            "address_2": "SUITE D",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301651536",
            "telephone_number": "706-232-6600",
            "fax_number": "706-232-6677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 REDMOND RD NW",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301651536",
            "telephone_number": "706-232-6600",
            "fax_number": "706-232-6677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PANSY'S POST MASTECTOMY BOUTIQUE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-01",
        "last_updated": "2014-09-12",
        "status": "A",
        "authorized_official_last_name": "GOEWEY",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "706-232-6600",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "GA",
            "license": "000484",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "585652876B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Abigael Panares, PT
• Mantu Manvir Panchhi, DC
• Darshak Krishnakant Pandya, DO
• Dhruv K Pandya, MD
• Siena Pangtay, DO
• Caroline Thoms Parker, AGPCNP-BC
• Desmond Parker, PTA
• Zara Michele Parkinson, MD
• Laura Spragens Parkman, DMD
• Keith M. Parmer, M.D.

• Durable Medical Equipment & Medical Supplies in Rome, GA
• Providers in Rome, GA by specialty
• Durable Medical Equipment & Medical Supplies in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2014; 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.