Provider Demographics
NPI:1588952691
Name:ANNS LINGERIE AND MASTECTOMY CENTER INC
Entity type:Organization
Organization Name:ANNS LINGERIE AND MASTECTOMY CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-878-4144
Mailing Address - Street 1:13483 OLIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3166
Mailing Address - Country:US
Mailing Address - Phone:314-878-4144
Mailing Address - Fax:314-878-9146
Practice Address - Street 1:210 HARTMAN LN
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1779
Practice Address - Country:US
Practice Address - Phone:618-624-8010
Practice Address - Fax:318-624-8131
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANN'S LINGERIE AND MASTECTOMY CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-11
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies