MEDICARE: THE LANE BEAUTY HOLDINGS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1679148522
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE LANE BEAUTY HOLDINGS LLC

Provider Business Mailing Address
First Line	:	7416 WOODLAND WAY
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63121-2546
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7416 WOODLAND WAY
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63121-2546
Country	:	US
Telephone Number	:	830-624-3038
Fax Number	:

Authorized Official
Title or Position	:	LLC MEMBER
Name	:	BARBARA LANE-SNOWDEN
Credential	:
Telephone Number	:	830-624-3038

Provider Enumeration Date	:	05/24/2021
Last Update Date	:	05/24/2021

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Directions to “THE LANE BEAUTY HOLDINGS LLC ” Practice Location

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