Organization
STAGE 1 HAIR LOSS REPLACEMENT & SALON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALANDA K TILLMAN (PROVIDER)
(601) 384-4532
Entity
Organization
Contact information
Practice address
216 MAIN STREET, MEADVILLE, MS 39653
(601) 384-4532
(601) 384-8334
Mailing address
PO BOX 240, MEADVILLE, MS 39653-0240
(601) 384-4532
(601) 384-4532
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306214507
—
MS
Enumeration date
01/31/2023
Last updated
07/17/2023
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