Provider Demographics
NPI:1841284593
Name:LORETTA'S INTIMATES INC
Entity type:Organization
Organization Name:LORETTA'S INTIMATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRITTS
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:972-633-9100
Mailing Address - Street 1:721 N CENTRAL EXPY
Mailing Address - Street 2:#420
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-8843
Mailing Address - Country:US
Mailing Address - Phone:972-633-9100
Mailing Address - Fax:972-424-3377
Practice Address - Street 1:721 N CENTRAL EXPY
Practice Address - Street 2:#420
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-8843
Practice Address - Country:US
Practice Address - Phone:972-633-9100
Practice Address - Fax:972-424-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1313480001Medicare ID - Type Unspecified