Phats Extension Bar & Makeup Studio LLC

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

Legal business name

PHATS EXTENSION BAR & MAKEUP STUDIO LLC

Practice address

1950 N Northwest Loop 323
Tyler, TX 75702-1626

Phone

(903) 747-8060

Fax

(903) 747-8060

NPI assigned

May 25, 2021

Organization subpart

No

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

Authorized official

Name

Kimberly Denise Shead, HLP

Title

Hair Loss Practtitioner/Owner

Phone

(903) 722-0734

Specialties & licenses 1

Addresses

Other names 1

• PHATS EXTENSION BAR Former legal business name

Locations

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

{
    "created_epoch": "1621900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621900800000",
    "number": "1457926164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 N NORTHWEST LOOP 323",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757021626",
            "telephone_number": "903-747-8060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 N NORTHWEST LOOP 323",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757021626",
            "telephone_number": "903-747-8060",
            "fax_number": "903-747-8060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHATS EXTENSION BAR & MAKEUP STUDIO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-25",
        "last_updated": "2021-05-25",
        "certification_date": "2021-05-25",
        "status": "A",
        "authorized_official_last_name": "SHEAD",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "HAIR LOSS PRACTTITIONER/OWNER",
        "authorized_official_telephone_number": "903-722-0734",
        "authorized_official_credential": "HLP"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHATS EXTENSION BAR",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Christopher Pham
• Thinh Sy-Quoc Pham, D.D.S.
• Phu Cuong Phan, MD
• Pharmacy Corporation of America
• Pharmscript of Texas, LLC
• PHCS I Inc
• PHCS IV, Inc.
• Daniel Hubbard Phelps, DPM
• Robert Daniel Phelps, DPM
• Janna Tracy Phifer, RD, LDN

• Customized Equipment (DME) in Tyler, TX
• Providers in Tyler, TX by specialty
• Customized Equipment (DME) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2021; 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.