Mary's Majestic Medical Wigs

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

MARY'S MAJESTIC MEDICAL WIGS

Practice address

2589 Wiley Ave
Mims, FL 32754-4506

Phone

(321) 603-1761

Fax

(321) 603-1761

NPI assigned

Aug 14, 2023

Last updated

Aug 14, 2023By 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

Mary Johnson

Title

Cranial Prosthesis Specialist

Phone

(321) 603-1761

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

{
    "created_epoch": "1691971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691971200000",
    "number": "1518640705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3155 COLUMBIA BLVD # 1035",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327807820",
            "telephone_number": "321-603-1761",
            "fax_number": "321-603-1761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2589 WILEY AVE",
            "city": "MIMS",
            "state": "FL",
            "postal_code": "327544506",
            "telephone_number": "321-603-1761",
            "fax_number": "321-603-1761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY'S MAJESTIC MEDICAL WIGS",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-14",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-13",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "CRANIAL PROSTHESIS SPECIALIST",
        "authorized_official_telephone_number": "321-603-1761"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "321-603-1761",
            "affiliation": "N",
            "endpointDescription": "Fax",
            "address_1": "2589 Wiley Ave",
            "city": "Mims",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327544506",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Prosthetic/Orthotic Supplier in Mims, FL
• Providers in Mims, FL by specialty
• Prosthetic/Orthotic Supplier in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; 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.