Mastectomy Shoppe, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

MASTECTOMY SHOPPE, LLC

Doing business as

Pink Ribbon Gals

Practice address

9700 Redstone Dr Ste 200
Indian Land, SC 29707-5409

Phone

(803) 548-8627

Fax

(803) 548-8630

NPI assigned

Nov 2, 2021

Organization subpart

No

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

Authorized official

Name

Christen E Tese

Title

Managing Member

Phone

(561) 573-9596

Specialties & licenses 1

Addresses

Other names 1

• Pink Ribbon Gals Doing business as

Medicare fee-for-service enrollment

Enrolled in SC

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

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

{
    "created_epoch": "1635811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648684800000",
    "number": "1922763150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9700 REDSTONE DR STE 200",
            "city": "INDIAN LAND",
            "state": "SC",
            "postal_code": "297075409",
            "telephone_number": "803-548-8627",
            "fax_number": "803-548-8630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9700 REDSTONE DR STE 200",
            "city": "INDIAN LAND",
            "state": "SC",
            "postal_code": "297075409",
            "telephone_number": "803-548-8627",
            "fax_number": "803-548-8630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASTECTOMY SHOPPE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-02",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A",
        "authorized_official_last_name": "TESE",
        "authorized_official_first_name": "CHRISTEN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "561-573-9596"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pink Ribbon Gals",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pink Ribbon Gals",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Matthew Earl Malus, MD
• Charles Manning, RPH
• Erin Burfield Marcotsis, MD
• Michael Arthur Marshall, D.M.D.
• Masifitnessllc
• Malcolm Matheson, PHARMD
• Teresa Matthews
• Ashleigh McAteer
• Inez McCall
• Matthew McCall, PHARMD

• Durable Medical Equipment & Medical Supplies in Indian Land, SC
• Providers in Indian Land, SC by specialty
• Durable Medical Equipment & Medical Supplies in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2022; 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.