Broadband Innovation Group

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

BROADBAND INNOVATION GROUP

Doing business as

Innovation Hair Clinic

Practice address

2915 Raeford Rd Ste 203
Fayetteville, NC 28303-5491

Phone

(910) 378-1966

Fax

(910) 378-1962

NPI assigned

Nov 30, 2018

Organization subpart

No

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

Authorized official

Name

Mr. Levi Samuels Jr.

Title

VP of Business & Operations

Phone

(910) 824-2872

Specialties & licenses 2

Addresses

Other names 1

• Innovation Hair Clinic Doing business as

Locations

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

{
    "created_epoch": "1543536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549411200000",
    "number": "1720558893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 HAY ST STE 102",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283015581",
            "telephone_number": "910-824-2872",
            "fax_number": "910-378-1962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2915 RAEFORD RD STE 203",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283035491",
            "telephone_number": "910-378-1966",
            "fax_number": "910-378-1962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADBAND INNOVATION GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-30",
        "last_updated": "2019-02-06",
        "status": "A",
        "authorized_official_last_name": "SAMUELS",
        "authorized_official_first_name": "LEVI",
        "authorized_official_title_or_position": "VP OF BUSINESS & OPERATIONS",
        "authorized_official_telephone_number": "910-824-2872",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Innovation Hair Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Innovation Hair Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica Lauren Britt, PHARMD
• Kellie Britt, NP
• Samantha Curley Britt, LPA
• Britthaven, Inc.
• Rita Brizuela
• Andrea Broadnax
• Heather Marie Brock, LCSW-A
• Melissa Rhynes Brock, LPC LCAS
• Wendy Lynn Brock, NNP
• Brockett Investments LLC

• Prosthetic/Orthotic Supplier in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Prosthetic/Orthotic Supplier in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2019; 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.