Provider Demographics
NPI:1821122615
Name:LADIES HEALTH BOUTIQUE,INC
Entity Type:Organization
Organization Name:LADIES HEALTH BOUTIQUE,INC
Other - Org Name:FOR LADIES ONLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-979-4377
Mailing Address - Street 1:650 OLDE TOWNE ROAD
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216
Mailing Address - Country:US
Mailing Address - Phone:205-979-4377
Mailing Address - Fax:205-822-5341
Practice Address - Street 1:650 OLDE TOWNE RD
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-3758
Practice Address - Country:US
Practice Address - Phone:205-979-4377
Practice Address - Fax:205-822-5341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3700 54926332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009981090Medicaid
AL1124030001Medicare NSC