Provider Demographics
NPI:1891083952
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/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
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:63017-3166
Mailing Address - Country:US
Mailing Address - Phone:314-878-4144
Mailing Address - Fax:314-878-9146
Practice Address - Street 1:974 WENTZVILLE PKWY
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-3695
Practice Address - Country:US
Practice Address - Phone:636-332-6700
Practice Address - Fax:636-332-6811
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANNS LINGERIE AND MASTECTOMY CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-11
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6296928808Medicaid