Organization Name: | CAROL'S PERSONAL MASTECTOMY BOUTIQUE OF SOUTHERN UTAH LLC |
NPI Number: | 1013014240 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JENNIFER STENQUIST FLOWERS (OWNER) |
Mailing Address: | 330 East 600 South St George |
State: | UT US |
Postal Code: | 847706661 |
Phone Number: | 4356880452 |
Fax Number: | 4356880453 |
NPI Enumeration Date: | 09/20/2006 |
NPI Last Update Date: | 11/08/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |