Provider Demographics
NPI:1063599728
Name:PROFESSIONAL FASHION UNIFORMS
Entity type:Organization
Organization Name:PROFESSIONAL FASHION UNIFORMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:573-651-3513
Mailing Address - Street 1:46 S PLAZA WAY
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5809
Mailing Address - Country:US
Mailing Address - Phone:573-651-3513
Mailing Address - Fax:573-651-8990
Practice Address - Street 1:46 S PLAZA WAY
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5809
Practice Address - Country:US
Practice Address - Phone:573-651-3513
Practice Address - Fax:573-651-8990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO335E00000X335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4185910001Medicare ID - Type Unspecified