Provider Demographics
NPI:1568583276
Name:LUV LINGERIE AND BOUTIQUE
Entity Type:Organization
Organization Name:LUV LINGERIE AND BOUTIQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOU
Authorized Official - Middle Name:A
Authorized Official - Last Name:RABURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-735-2930
Mailing Address - Street 1:1615 TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77611-3530
Mailing Address - Country:US
Mailing Address - Phone:409-735-2930
Mailing Address - Fax:409-735-4513
Practice Address - Street 1:1615 TEXAS AVE
Practice Address - Street 2:
Practice Address - City:BRIDGE CITY
Practice Address - State:TX
Practice Address - Zip Code:77611-3530
Practice Address - Country:US
Practice Address - Phone:409-735-2930
Practice Address - Fax:409-735-4513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX519608OtherBLUECROSSBLUESHEILD
TX1059700001Medicare NSC