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Organization

FORTIETH & VINEYARD COMPANY LLC

Active
Other names
Wigs 2 Wellness
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. STACEY YVONNE PEGUES SPECIALIST (CRANIAL PROSTHESIS SPECIALISTS)
(314) 496-0178
Entity
Organization

Contact information

Practice address
10781 NORTH OUTER 40 ROAD, 117, CHESTERFIELD, MO 63005
(314) 496-0178
Mailing address
2369 WESFORD DR, MARYLAND HEIGHTS, MO 63043-4147
(314) 496-0178

Taxonomy

Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary

Other

Enumeration date
07/24/2023
Last updated
07/24/2023
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