Provider Demographics
NPI:1114035003
Name:UNDERWEAR HOUSE, INC.
Entity Type:Organization
Organization Name:UNDERWEAR HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRITTS
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:708-425-2727
Mailing Address - Street 1:3613 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2119
Mailing Address - Country:US
Mailing Address - Phone:708-425-2727
Mailing Address - Fax:708-425-2775
Practice Address - Street 1:3613 W 95TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2119
Practice Address - Country:US
Practice Address - Phone:708-425-2727
Practice Address - Fax:708-425-2775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL31696864335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3945190001Medicare ID - Type Unspecified