1740488048 NPI number — SHOE SOLUTIONS INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740488048 NPI number — SHOE SOLUTIONS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHOE SOLUTIONS INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740488048
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 SEA MARSH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FERNANDINA BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32034-5051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-491-1441
Provider Business Mailing Address Fax Number:
904-491-1441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2152 SADLER RD
Provider Second Line Business Practice Location Address:
SUITE 20
Provider Business Practice Location Address City Name:
FERNANDINA BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32034-4451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-261-6886
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HUNTER
Authorized Official First Name:
DON
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
904-614-0046

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  PED87 PT2669 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)