Provider Demographics
NPI:1013909308
Name:LINGERIE LINE LLC
Entity Type:Organization
Organization Name:LINGERIE LINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:B
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-656-4090
Mailing Address - Street 1:PO BOX 18301
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-0301
Mailing Address - Country:US
Mailing Address - Phone:210-656-4090
Mailing Address - Fax:210-946-5471
Practice Address - Street 1:8209 ROUGHRIDER DR
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78239-2434
Practice Address - Country:US
Practice Address - Phone:210-656-4090
Practice Address - Fax:210-946-5471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX530034OtherBLUE CROSS BLUE SHIELD
TX011042101Medicaid
TX011042102Medicaid
TX6054030001Medicare NSC