Provider Demographics
NPI:1174669667
Name:HAIR DESIGNER
Entity type:Organization
Organization Name:HAIR DESIGNER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:POTEAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-652-5929
Mailing Address - Street 1:406 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-4049
Mailing Address - Country:US
Mailing Address - Phone:828-652-5929
Mailing Address - Fax:
Practice Address - Street 1:406 E COURT ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-4049
Practice Address - Country:US
Practice Address - Phone:828-652-5929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4138860001Medicare NSC
4138860001Medicare NSC