Healthcare Provider Details

I. General information

NPI: 1912123795
Provider Name (Legal Business Name): B & B LINGERIE COMPANY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2417 BANK DR SUITE 201
BOISE ID
83705-2570
US

IV. Provider business mailing address

PO BOX 5731
BOISE ID
83705-0731
US

V. Phone/Fax

Practice location:
  • Phone: 208-343-9696
  • Fax: 208-343-9266
Mailing address:
  • Phone: 208-343-9696
  • Fax: 208-343-9266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. STACIE Q NEELY
Title or Position: PRESIDENT
Credential:
Phone: 208-343-9696