Ian Bradley Hair Salon LLC
Prosthetic/Orthotic Supplier in Macon, GA. Organization (NPI-2).
NPI number1073239265
StatusActive
Last updated in NPPESOct 18, 2022
Details
- NPI
- 1073239265
- Entity type
- Organization (NPI-2)
- Legal business name
- Ian Bradley Hair Salon LLC
- Organization subpart
- No
- Enumeration date
- Oct 18, 2022
- Certification date
- Oct 18, 2022
- Last updated
- Oct 18, 2022
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 335E00000X | Prosthetic/Orthotic Supplier | – | – | Yes |
Practice location
3902 Northside Dr Ste A3Macon, GA 31210-2459
Phone 478-845-1210 · Fax 478-210-5078
Mailing address
222 Joycliff CirMacon, GA 31211-7040
Phone 478-714-4302 · Fax 478-210-5078
Authorized official
Melissa R McCoy
Owner
4787144302
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