1821033267 NPI number — MARGRET'S MASTECTOMY SHOPPE, LTD.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821033267 NPI number — MARGRET'S MASTECTOMY SHOPPE, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARGRET'S MASTECTOMY SHOPPE, LTD.
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:
6
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:
1821033267
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 805
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANFIELD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44406-0805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-518-3703
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
95 ARCH ST
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44304-1437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-761-2700
Provider Business Practice Location Address Fax Number:
330-761-2701
Provider Enumeration Date:
06/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CIANCIOLA
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
VP OPERATIONS
Authorized Official Telephone Number:
330-518-3703

Provider Taxonomy Codes

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

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

  • Identifier: 2062422 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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