Premier Mastectomy Vendor LLC

NPI #1699458380 in Montgomery, Alabama

Provider Information

NPI Number: 1699458380
Entity Type: Organization
Organization Name: Premier Mastectomy Vendor LLC
Primary Specialty: Mastectomy Fitter
Enumeration Date: Aug 9, 2023
Last Updated: Dec 20, 2023

Practice Location

Address: 5911 MONTICELLO DR STE B
City: Montgomery
State: Alabama
ZIP Code: 36117-1940
Phone: (629) 279-5720

Authorized Official

Name: MS. JASMINE BEAN
Title: CO-OWNER
Phone: (629) 279-5270

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Massage Therapist	225700000X
Mastectomy Fitter	224900000X	Primary

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MRS. Jasmine Graham, BSHA, CFM	Mastectomy Fitter	Montgomery	AI Deep Dive
Denise Holton Newby, CFM	Mastectomy Fitter	Dothan	AI Deep Dive
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