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General NPI Number Information
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NPI Number | 1356009658
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Entity Type | Organization
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Legal Business Name | BOMBEAU LUX, LLC
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Dates
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Enumeration Date | 12/03/2021
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Last Update Date | 12/03/2021
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Provider Practice Location Address
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Address Line | 9 LEIMS RD
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City | PARK FOREST
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State | IL
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Zip | 60466
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Country | US
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Telephone | 708-829-2233
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Fax | 217-394-1376
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Provider Business Mailing Address
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Address Line | 20015 S LAGRANGE RD # 1160
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City | FRANKFORT
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State | IL
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Zip | 60423-3104
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Country | US
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Telephone |
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Fax | 217-394-1376
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Authorized Official
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Title or Position | CEO
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Name | MISS SYDNIE STENNIS
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Credential |
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Telephone | 708-829-2233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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