Provider Demographics
NPI:1750900114
Name:EXPERIENCE LEMIEUX
Entity type:Organization
Organization Name:EXPERIENCE LEMIEUX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-997-1096
Mailing Address - Street 1:900 N 19TH ST UNIT 3247
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-1561
Mailing Address - Country:US
Mailing Address - Phone:267-997-1096
Mailing Address - Fax:855-375-7029
Practice Address - Street 1:900 N 19TH ST UNIT 3247
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-1561
Practice Address - Country:US
Practice Address - Phone:267-997-1096
Practice Address - Fax:855-375-7029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA839670OtherLLC