Stacey'S Bra and Lingerie Shop, Inc

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

STACEY'S BRA AND LINGERIE SHOP, INC

Practice address

10453 Hickman Road
Urbandale, IA 50322-5032

Phone

(515) 226-9336

NPI assigned

Nov 13, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stacey Ann Burns-Fox, CFM

Title

President

Phone

(515) 270-1399

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Stacey's Mastectomy Center Doing business as

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654732800000",
    "number": "1720159452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10453 HICKMAN ROAD",
            "city": "URBANDALE",
            "state": "IA",
            "postal_code": "50322",
            "telephone_number": "515-270-1399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10453 HICKMAN ROAD",
            "city": "URBANDALE",
            "state": "IA",
            "postal_code": "503225032",
            "telephone_number": "515-226-9336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STACEY'S BRA AND LINGERIE SHOP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2022-06-09",
        "certification_date": "2022-06-02",
        "status": "A",
        "authorized_official_last_name": "BURNS-FOX",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "515-270-1399",
        "authorized_official_credential": "CFM"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0102509",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stacey's Mastectomy Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Stacey's Mastectomy Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Prosthetic/Orthotic Supplier in Urbandale, IA
• Providers in Urbandale, IA by specialty
• Prosthetic/Orthotic Supplier in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.