Organization
BROADBAND INNOVATION GROUP
Active
Organization
BROADBAND INNOVATION GROUP
Active
Other names
Innovation Hair Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEVI SAMUELS JR. (VP OF BUSINESS & OPERATIONS)
(910) 824-2872
Entity
Organization
Contact information
Practice address
2915 RAEFORD RD STE 203, FAYETTEVILLE, NC 28303-5491
(910) 378-1966
(910) 378-1962
Mailing address
201 HAY ST STE 102, FAYETTEVILLE, NC 28301-5581
(910) 824-2872
(910) 378-1962
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
11/30/2018
Last updated
02/06/2019
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