1447394580 NPI number — DIABETIC COMFORT FOOTWEAR, INC.

Table of content: (NPI 1447394580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447394580 NPI number — DIABETIC COMFORT FOOTWEAR, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIABETIC COMFORT FOOTWEAR, 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:
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:
1447394580
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5130 CHARLESTOWN RD
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
NEW ALBANY
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47150-9483
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-821-8783
Provider Business Mailing Address Fax Number:
812-949-0279

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5130 CHARLESTOWN RD
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
NEW ALBANY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47150-9483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-821-8783
Provider Business Practice Location Address Fax Number:
812-949-0279
Provider Enumeration Date:
02/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOHAMMED
Authorized Official First Name:
MONICA
Authorized Official Middle Name:
FOUST
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
502-821-8783

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2514112 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90009192 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com