1073879599 NPI number — IT'S MAGIC MOMENTS LINGERIE

Table of content: (NPI 1073879599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073879599 NPI number — IT'S MAGIC MOMENTS LINGERIE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IT'S MAGIC MOMENTS LINGERIE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073879599
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 ROLLING HILLS PL
Provider Second Line Business Mailing Address:
APT. 2006
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75146-1027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-685-5577
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
231 E BELT LINE RD
Provider Second Line Business Practice Location Address:
BLDG. 2, SUITE 5
Provider Business Practice Location Address City Name:
DESOTO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75115-5776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-685-5577
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DAWN-DARNELL
Authorized Official First Name:
ROSSLAND
Authorized Official Middle Name:
RESHELL
Authorized Official Title or Position:
OWNER/ OPERATOR
Authorized Official Telephone Number:
469-685-5577

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)