Organization
CAMEO BRA SHOP
Active
Organization
CAMEO BRA SHOP
Active
Other names
Mary R Tuttle
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY SUE R TUTTLE (OWNER MANAGER)
(336) 591-4118
Entity
Organization
Contact information
Practice address
1020 HINSDALE RD, WALNUT COVE, NC 27052-6802
(336) 591-4118
(336) 591-4118
Mailing address
1020 HINSDALE RD, WALNUT COVE, NC 27052-6802
(336) 591-4118
(336) 591-4118
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
046FJ
BCBS
—
01
—
5978660001
CIGNA HEALTH CARE
NC
05
—
7704224
—
NC
01
—
805501
PARTNERS
—
Enumeration date
11/30/2005
Last updated
06/12/2008
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