| The Mastectomy Boutique | |
|
4700 Wichers Dr Suite 201 Marrero LA 70072-3041 | |
| (504) 758-4220 | |
| Not Available |
| Full Name | The Mastectomy Boutique |
|---|---|
| Speciality | Durable Medical Equipment & Medical Supplies |
| Location | 4700 Wichers Dr, Marrero, Louisiana |
| Authorized Official Name and Position | Iisha K Bailey (MANAGER) |
| Authorized Official Contact | 5047584220 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Mastectomy Boutique Po Box 2864 Harvey LA 70059-2864 Ph: (504) 758-4220 | The Mastectomy Boutique 4700 Wichers Dr Suite 201 Marrero LA 70072-3041 Ph: (504) 758-4220 |
| NPI Number | 1124568571 |
|---|---|
| Provider Enumeration Date | 03/06/2017 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 7719220995 |
|---|---|
| Medicare Enrollment ID | O20211210001454 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124568571 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Secondary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | (Louisiana) | Primary |
| 335E00000X | Prosthetic/orthotic Supplier | () | Secondary |
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