THE FORMS BOUTIQUE, INC. (NPI# 1689768376) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689768376 |
| Entity Type | Organization |
| Organization Name | THE FORMS BOUTIQUE, INC. |
| Practice Address |
3308 Forest Dr Columbia SC 29204-4024 |
| Practice Telephone | 8037388400 |
| Practice Fax Number | 8037388498 |
| Mailing Telephone | 8037388400 |
| Mailing Fax Number | 8037388498 |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2020-03-17 |
| Authorized Official Name | MRS. AMY D. MCLELLAN (PRESIDENT) |
| Authorized Official Telephone | 8037997096 |
| Authorized Official Credential | RFM, CMF |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 335E00000X | Prosthetic/Orthotic Supplier | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | 556570 | 05 |
| Street Address |
3308 FOREST DR |
| City | COLUMBIA |
| State | SC |
| Zip Code | 29204-4024 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992215149 | Ricardo Colon II | Registered Nurse | 3000 Hampton Street, Columbia, SC 29204 | 2017-10-02 |
| 1780113522 | Carla Star Noe | Registered Nurse | Sc Department of Health and Environmental Control, 2100 Bull Street, Collumbia, SC 29204 | 2017-06-06 |
| 1124568514 | Kristy L Thompson | Nurse Practitioner | 1655 Bernardin Ave Ste 240, Columbia, SC 29204 | 2017-03-03 |
| 1982052031 | Harold Eugene Cook Iv | Podiatrist | 1730 St Julian Place, Columbia, SC 29204 | 2016-05-31 |
| 1851748974 | Shaquita Banks | Counselor | 1810 Allen Benedict Ct, A1, Columbia, SC 29204 | 2016-05-18 |
| 1265804835 | Premier Care, LLC | Case Management | 2712 Middleburg Drive, Suite 206, Columbia, SC 29204 | 2015-10-22 |
| 1023492287 | Shamiquia N. Mcpherson | Counselor | 1627 Auburn St., Columbia, SC 29204 | 2015-07-16 |
| 1285028449 | The Columbia Free Medical Clinic, Inc. | Clinic/Center | 1875 Harden Street, Columbia, SC 29204 | 2015-03-26 |
| 1629473459 | Leslie Wilson | Counselor | 2323 Lady Street, Columbia, SC 29204 | 2014-10-22 |
| 1053728683 | Candyce Sutton | Social Worker | 1135 Carter Street, Columbia, SC 29204 | 2014-07-15 |
| Find all providers in zip 29204 | ||||
| Taxonomy Code | 335E00000X |
| Grouping | Suppliers |
| Classification | Prosthetic/Orthotic Supplier |
| An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598259954 | Natural Wigs Store | Prosthetic/Orthotic Supplier | 1722 Broad River Rd Ste C, Columbia, SC 29210-7336 | 2018-06-19 |
| 1215279013 | Mochix | Prosthetic/Orthotic Supplier | 2601 Maguire Blvd, Columbia, MO 65201-8253 | 2013-03-20 |
| 1992041867 | Level Four Orthotics & Prosthetics, Inc. | Prosthetic/Orthotic Supplier | 3250 Harden Street Ext Ste 200, Columbia, SC 29203 | 2012-12-21 |
| 1649550963 | The Welbourne Group,llc | Prosthetic/Orthotic Supplier | 6830 Garners Ferry Rd, Columbia, SC 29209-1609 | 2011-08-17 |
| 1619296175 | Comforting Solutions, LLC | Prosthetic/Orthotic Supplier | 12118 Little Patuxent Pkwy Apt H, Columbia, MD 21044-2759 | 2010-05-24 |
| 1205016219 | Orthopartners Inc | Prosthetic/Orthotic Supplier | 6760 Alexander Bell Dr, Suite 150, Columbia, MD 21046-2191 | 2007-11-07 |
| 1851302244 | Cook's Orthopedics, Inc. | Prosthetic/Orthotic Supplier | 1503 Hatcher Ln, Suite 140, Columbia, TN 38401-4833 | 2006-08-10 |
| 1417962275 | Central Brace Company | Prosthetic/Orthotic Supplier | 404 Portland St, Rear Entrance Eye Research Foundation, Columbia, MO 65201-6506 | 2006-07-30 |
| 1366460248 | Alala, LLC | Prosthetic/Orthotic Supplier | 3400 Harden Street Ext, Columbia, SC 29203 | 2006-07-18 |
| 1881610293 | Nordstrom Inc & Subsidiaries | Prosthetic/Orthotic Supplier | 10300 Little Patuxent Pkwy # 1, Columbia, MD 21044-3341 | 2006-07-15 |
| Find all providers in COLUMBIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.