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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