Provider Demographics
NPI:1396257077
Name:SHOWTYME INTERNATIONAL HAIR & SHOW
Entity type:Organization
Organization Name:SHOWTYME INTERNATIONAL HAIR & SHOW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:GILREATH
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIEDHAIRLOSSSPE
Authorized Official - Phone:407-246-7076
Mailing Address - Street 1:2123 W COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6946
Mailing Address - Country:US
Mailing Address - Phone:407-246-7076
Mailing Address - Fax:
Practice Address - Street 1:2123 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6946
Practice Address - Country:US
Practice Address - Phone:407-246-7076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment