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General NPI Number Information
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NPI Number | 1912123795
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Entity Type | Organization
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Legal Business Name | B & B LINGERIE COMPANY, INC.
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2417 BANK DR SUITE 201
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City | BOISE
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State | ID
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Zip | 83705-2570
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Country | US
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Telephone | 208-343-9696
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Fax | 208-343-9266
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Provider Business Mailing Address
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Address Line | PO BOX 5731
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City | BOISE
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State | ID
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Zip | 83705-0731
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Country | US
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Telephone | 208-343-9696
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Fax | 208-343-9266
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. STACIE Q NEELY
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Credential |
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Telephone | 208-343-9696
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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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