Provider Demographics
NPI:1295110054
Name:IRENE STEPHENS DBA IRENES SHEAR MADNESS
Entity type:Organization
Organization Name:IRENE STEPHENS DBA IRENES SHEAR MADNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-788-7832
Mailing Address - Street 1:2000 CLEMSON RD
Mailing Address - Street 2:SUITEB 5
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-9538
Mailing Address - Country:US
Mailing Address - Phone:803-788-7832
Mailing Address - Fax:
Practice Address - Street 1:2000 CLEMSON RD
Practice Address - Street 2:SUITE 5
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-9538
Practice Address - Country:US
Practice Address - Phone:803-788-7832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MANE ATTRACTION ON CLEMSON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29166335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier