Provider Demographics
NPI:1891939633
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:S
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-979-4377
Mailing Address - Street 1:3608 HYW 118E
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35504
Mailing Address - Country:US
Mailing Address - Phone:205-221-7157
Mailing Address - Fax:205-822-5341
Practice Address - Street 1:3608 HIGHWAY 78 E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-8909
Practice Address - Country:US
Practice Address - Phone:205-221-7157
Practice Address - Fax:205-221-7159
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LADIES HEALTH BOUTIQUE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-23
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009981090Medicaid
AL51031506OtherBSBC
AL1124030002Medicare NSC