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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