The Wig Reviver

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

Legal business name

THE WIG REVIVER

Doing business as

The Wig Reviver

Practice address

503 36TH St SE Apt C
Largo, FL 33771-2716

Phone

(980) 616-0374

NPI assigned

Nov 25, 2022

Organization subpart

No

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

Authorized official

Name

Monica Elliott, PROSTHETICSPECIALISTNPI 1093425571

Title

Owner

Phone

(980) 616-0374

Specialties & licenses 1

Addresses

Other names 1

• The Wig Reviver Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Monica Elliott

  • Prosthetic/Orthotic Supplier
  • Largo, FL
  • NPI 1093425571
  NPD Authorized official

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

{
    "created_epoch": "1669334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669766400000",
    "number": "1962112474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "503 36TH ST SE APT C",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337712716",
            "telephone_number": "980-616-0374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 36TH ST SE APT C",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337712716",
            "telephone_number": "980-616-0374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WIG REVIVER",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-25",
        "last_updated": "2022-11-30",
        "certification_date": "2022-11-30",
        "status": "A",
        "authorized_official_last_name": "ELLIOTT",
        "authorized_official_first_name": "MONICA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "980-616-0374",
        "authorized_official_credential": "PROSTHETICSPECIALIST"
    },
    "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": "The Wig Reviver",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Customized Equipment (DME) in Largo, FL
• Providers in Largo, FL by specialty
• Customized Equipment (DME) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2022; 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.