Provider Demographics
NPI:1356009658
Name:BOMBEAU LUX, LLC
Entity Type:Organization
Organization Name:BOMBEAU LUX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:SYDNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-829-2233
Mailing Address - Street 1:20015 S LAGRANGE RD # 1160
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-3104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:217-394-1376
Practice Address - Street 1:9 LEIMS RD
Practice Address - Street 2:
Practice Address - City:PARK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60466
Practice Address - Country:US
Practice Address - Phone:708-829-2233
Practice Address - Fax:217-394-1376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier