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Organization
WONDERFUL WIGS ON THE GO, LLC
Active
Organization
WONDERFUL WIGS ON THE GO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WANDA D MOORE SUPPLIER (OWNER)
(817) 930-2595
Entity
Organization
Contact information
Practice address
1200 BRIDGEWOOD DR STE 406, FORT WORTH, TX 76112-0801
(817) 930-2595
Mailing address
600 W 6TH ST STE 400K, FORT WORTH, TX 76102-3684
(817) 930-2595
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659031391
—
TX
Enumeration date
12/21/2021
Last updated
07/23/2024
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