MEDICARE: LINGERIE LINE 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)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	530034	OTHER	TX	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013909308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINGERIE LINE LLC

Provider Business Mailing Address
First Line	:	PO BOX 18301
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-0301
Country	:	US
Telephone Number	:	210-656-4090
Fax Number	:	210-946-5471

Provider Business Practice Location Address
First Line	:	8209 ROUGHRIDER DR
Second Line	:	SUITE 102
City	:	SAN ANTONIO
State	:	TX
Zip	:	78239-2434
Country	:	US
Telephone Number	:	210-656-4090
Fax Number	:	210-946-5471

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. LINDA B RAMIREZ
Credential	:
Telephone Number	:	210-656-4090

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	02/23/2023

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Directions to “LINGERIE LINE LLC ” Practice Location

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