Brilliant Medical Boutique Llc

LBN: Brilliant Medical Boutique Llc
Brilliant Medical Boutique Llc is an health care organization with primary practice located at 925 Santa Fe Dr Suite 100, Weatherford TX 76086-5866. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Durable Medical Equipment & Medical Supplies, Suppliers / Prosthetic/Orthotic Supplier. Suppliers / Durable Medical Equipment & Medical Supplies is the primary health care specialty. Brilliant Medical Boutique Llc can be contacted via phone (817) 594-5868, or through Mittendorf, Jamie B. via phone (817) 594-5868.

Contact Information

Primary practice address
925 Santa Fe Dr Suite 100 Weatherford TX 76086-5866
Phone: (817) 594-5868
Fax: (817) 594-5833
Website:
Map and Directions
Authorized official contact:
Name: Mittendorf, Jamie B.
Phone: (817) 594-5868

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Durable Medical Equipment & Medical Supplies 332B00000X
Suppliers / Prosthetic/Orthotic Supplier 335E00000X

Profile Details

NPI number 1497793830
LBN Legal business name Brilliant Medical Boutique Llc
DBA Doing business as
Authorized official Mittendorf, Jamie B.
Entity Organization
Organization subpart 1 No
Enumeration date Jun 4th, 2006
Last updated Sep 8th, 2022 - about 2 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1497793830 NPPES
Texas MEDICAID 178601402

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