Organization
MART BEAUTY SUPPLY
Active
Other names
WIG MARTREFLECTIONS
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. HILDA J. PATTERSON (PRESIDENT)
(540) 562-2728
Entity
Organization
Contact information
Practice address
3031 PETERS CREEK RD NW STE A, ROANOKE, VA 24019-2768
(540) 562-2728
(540) 562-2764
Mailing address
3031 PETERS CREEK RD NW STE A, ROANOKE, VA 24019-2768
(540) 562-2728
(540) 562-2764
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
091855
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
264475
ANTHEM
VA
01
—
277911
SOUTHERN HEALTH
VA
01
—
4670699
AETNA
VA
Enumeration date
11/13/2006
Last updated
08/22/2020
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