Provider Demographics
NPI:1194586115
Name:ELEGANT PROFILE LLC
Entity type:Organization
Organization Name:ELEGANT PROFILE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLAIMS/BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JUCHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-331-3480
Mailing Address - Street 1:2830 MAPLEWOOD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4114
Mailing Address - Country:US
Mailing Address - Phone:336-331-3480
Mailing Address - Fax:336-331-3484
Practice Address - Street 1:2830 MAPLEWOOD AVE STE A
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4114
Practice Address - Country:US
Practice Address - Phone:336-331-3480
Practice Address - Fax:336-331-3484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy FitterGroup - Single Specialty