Provider Demographics
NPI:1013164706
Name:ALETA'S BRAS & LINGERIE
Entity Type:Organization
Organization Name:ALETA'S BRAS & LINGERIE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALETA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-682-0132
Mailing Address - Street 1:5601 E CENTRAL AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-4245
Mailing Address - Country:US
Mailing Address - Phone:316-682-0132
Mailing Address - Fax:
Practice Address - Street 1:5601 E CENTRAL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4245
Practice Address - Country:US
Practice Address - Phone:316-682-0132
Practice Address - Fax:316-612-6970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS332BC3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0752080001Medicare NSC