Provider Demographics
NPI:1912123795
Name:B & B LINGERIE COMPANY, INC.
Entity Type:Organization
Organization Name:B & B LINGERIE COMPANY, INC.
Other - Org Name:BOSOM BUDDY BREAST FORMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:Q
Authorized Official - Last Name:NEELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-343-9696
Mailing Address - Street 1:PO BOX 5731
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-0731
Mailing Address - Country:US
Mailing Address - Phone:208-343-9696
Mailing Address - Fax:208-343-9266
Practice Address - Street 1:2417 BANK DR
Practice Address - Street 2:SUITE 201
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2570
Practice Address - Country:US
Practice Address - Phone:208-343-9696
Practice Address - Fax:208-343-9266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0227900001Medicare NSC