Provider Demographics
NPI:1891464533
Name:BOSSED UP UNLIMITED LLC
Entity Type:Organization
Organization Name:BOSSED UP UNLIMITED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHETIC/ORTHOTIC SUPPLIER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:DME
Authorized Official - Phone:973-953-6247
Mailing Address - Street 1:12616 BRAHMIN DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78724-4472
Mailing Address - Country:US
Mailing Address - Phone:973-953-6247
Mailing Address - Fax:
Practice Address - Street 1:4700 LOYOLA LN STE 106
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-3953
Practice Address - Country:US
Practice Address - Phone:512-900-7895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOSSED UP UNLIMITED LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment