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NPI Code Detail

MEDICARE: MCMAHAN SHOES OF NC INC

MEDICARE: MCMAHAN SHOES OF NC INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332BC3200XCustomized Equipment (DME)NC

General Provider Information

NPI Number : 1497879506
Entity Type Code : Organization
Provider Name (Legal Business Name) : MCMAHAN SHOES OF NC INC
Provider Business Mailing Address
First Line : 1809 E 7TH ST
Second Line :
City : CHARLOTTE
State : NC
Zip : 28204-2415
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1809 E 7TH ST
Second Line :
City : CHARLOTTE
State : NC
Zip : 28204-2415
Country : US
Telephone Number : 704-376-1406
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : JOHN MCMAHAN
Credential : CERTIFIED PEDORTHIST
Telephone Number : 704-376-1406
Provider Enumeration Date : 03/16/2007
Last Update Date : 01/22/2008

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Directions to “MCMAHAN SHOES OF NC INC ” Practice Location

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