Provider Demographics
NPI:1598722860
Name:ANNS LINGERIE AND MASTECTOMY CENTER, INC
Entity Type:Organization
Organization Name:ANNS LINGERIE AND MASTECTOMY CENTER, INC
Other - Org Name:ANN'S BRA SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:RFM, CMF
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
Mailing Address - Country:US
Mailing Address - Phone:314-878-4144
Mailing Address - Fax:314-878-9146
Practice Address - Street 1:13483 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3166
Practice Address - Country:US
Practice Address - Phone:314-878-4144
Practice Address - Fax:314-878-9146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO116131OtherBCBS PROVIDER NUMBER
MO6296928808Medicaid
MO6296928808Medicaid