Organization
MABELINE INC.
Active
Other names
Mabeline Wig Company
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY SCOTT ABRAHAM SR. (PRESIDENT)
(319) 363-3391
Entity
Organization
Contact information
Practice address
3136 MOUNT VERNON RD SE, SUITE B, CEDAR RAPIDS, IA 52403-3655
(319) 363-3391
(319) 364-8610
Mailing address
3136 MOUNT VERNON RD SE, SUITE B, CEDAR RAPIDS, IA 52403-3655
(319) 363-3391
(319) 364-8610
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
1-57-016146
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18351
WELLMARK BLUE CROSS BLUE SHIELD
IA
Enumeration date
05/13/2008
Last updated
05/13/2008
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