Wonderful Wigs on the Go, LLC

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

Legal business name

WONDERFUL WIGS ON THE GO, LLC

Practice address

1200 Bridgewood Dr Ste 406
Fort Worth, TX 76112-0801

Phone

(817) 930-2595

NPI assigned

Dec 21, 2021

Organization subpart

No

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

Authorized official

Name

Wanda D Moore, SUPPLIER

Title

Owner

Phone

(817) 930-2595

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1640044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721692800000",
    "number": "1659031391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 W 6TH ST STE 400K",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761023684",
            "telephone_number": "817-930-2595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 BRIDGEWOOD DR STE 406",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761120801",
            "telephone_number": "817-930-2595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WONDERFUL WIGS ON THE GO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-21",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "WANDA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-930-2595",
        "authorized_official_credential": "SUPPLIER"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1659031391",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "sales@wonderfulwigs.net",
            "affiliation": "N",
            "endpointDescription": "Laptop",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Supplier",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "600 W 6th St Ste 400K",
            "city": "Fort Worth",
            "state": "TX",
            "country_code": "US",
            "postal_code": "761023684",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Eric Matthew Womboldt
• Suzanne Sophia Wombough, FNP-C
• Craig Mahlon Womeldorph, DO
• Women'S Integrated Healthcare, P.a.
• Yared Astawesegn Wondemagegn, MD
• Christina A. Wong, PTA
• Cyrus CHI-Ho Wong, M.D.
• Evan Wong, MD
• Lai Yung Wong, OTR
• Lillian Wong

• Customized Equipment (DME) in Fort Worth, TX
• Providers in Fort Worth, 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 Jul 23, 2024; 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.