WIG WAM BOUTIQUE LLC (NPI# 1821504697) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821504697 |
| Entity Type | Organization |
| Organization Name | WIG WAM BOUTIQUE LLC |
| Practice Address |
313 W 17th St Bloomington IN 47404-3453 |
| Mailing Address |
397 S Gum St North Vernon IN 47265-2055 |
| Practice Telephone | 8123324914 |
| Enumeration Date | 2017-12-15 |
| Last Update Date | 2017-12-15 |
| Authorized Official Name | MARSHALENE EVANS (MEMBER & REGISTERED AGENT) |
| Authorized Official Telephone | 8124981857 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers |
| Street Address |
313 W 17TH ST |
| City | BLOOMINGTON |
| State | IN |
| Zip Code | 47404-3453 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013526631 | Sandra Clark | Counselor | 205 N College Avenue, Suite 210a, Bloomington, IN 47404 | 2020-07-29 |
| 1750926085 | Michelle Christine Dustin | Nurse Practitioner | 610 N Morton Street, Bloomigton, IN 47404 | 2019-11-11 |
| 1316440191 | Julie D'argent | Psychologist | 205 N College Ave Ste 430, Bloomington, IN 47404 | 2018-03-17 |
| 1770966467 | Richard Lawson | Counselor | 1117 North Jackson Street, Bloomington, IN 47404 | 2015-06-30 |
| 1477952109 | Teresa R. Foster | Social Worker | 205 N. College Avenue, Suite 210b, Bloomington, IN 47404 | 2014-08-19 |
| 1073879532 | First Health Plus, Inc | Clinic/Center | 104 North Curry Pike, Bloomington, IN 47404 | 2012-04-09 |
| 1497079982 | Tera Dee Nance | Counselor | 101 W. Kirkwood Avenue, Suite 009 Fountain Square Mall, Bloomington, IN 47404 | 2010-03-26 |
| 1962643114 | Pathways Counseling Center | Community/Behavioral Health | 3866 W. Third Street, Bloomington, IN 47404 | 2009-03-18 |
| 1932358595 | Catherine Elizabeth Batka | Psychologist | 101 W. Kirkwood Ave, Suite 103, Bloomington, IN 47404 | 2008-09-18 |
| 1396901005 | Kijin Woo | Dentist | 330 N Jacob Drive, Bloomington, IN 47404 | 2008-08-01 |
| Find all providers in zip 47404 | ||||
| Taxonomy Code | 332B00000X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient’s use in the home and that are usable for an extended period of time. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245797646 | D B Medical Supplies Inc | Durable Medical Equipment & Medical Supplies | 2601 General Electric Rd Ste 4, Bloomington, IL 61704-3437 | 2019-02-22 |
| 1538648571 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 702 W Chestnut St Ste 103, Bloomington, IL 61701-2814 | 2018-08-10 |
| 1881193274 | Orthopedic Rehabilitation Supply LLC | Durable Medical Equipment & Medical Supplies | 13 Norbloom Ave, Bloomington, IL 61701-1949 | 2018-02-12 |
| 1033622824 | Kroger Limited Partnership I | Durable Medical Equipment & Medical Supplies | 1825 N Kinser Pike, Bloomington, IN 47404-1914 | 2017-11-15 |
| 1629509732 | Touchway LLC | Durable Medical Equipment & Medical Supplies | 60 E Broadway, Bloomington, MN 55425-5510 | 2017-03-22 |
| 1437697935 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 445 S Landmark Ave Ste P, Bloomington, IN 47403-5004 | 2017-02-03 |
| 1861875403 | Hook Superx LLC | Durable Medical Equipment & Medical Supplies | 121 E Kirkwood Ave, Bloomington, IN 47408-3331 | 2015-07-01 |
| 1639479140 | Home Health Depot | Durable Medical Equipment & Medical Supplies | 13 Westport Ct, Unit B, Bloomington, IL 61704-3626 | 2010-10-31 |
| 1316178064 | Highland Park Cvs, L.L.C. | Durable Medical Equipment & Medical Supplies | 1130 S Veterans Pkwy, Bloomington, IL 61704 | 2009-07-29 |
| 1730316647 | Walmart Inc. | Durable Medical Equipment & Medical Supplies | 700 American Blvd E, Bloomington, MN 55420-1336 | 2009-06-18 |
| Find all providers in BLOOMINGTON | ||||
| City | BLOOMINGTON |
| Zip Code | 47404 |
Please comment or provide details below to improve the information on WIG WAM BOUTIQUE LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.