Healthcare Provider Details

I. General information

NPI: 1750317095
Provider Name (Legal Business Name): SHOE FITTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 W 38TH AVE
WHEAT RIDGE CO
80033-4841
US

IV. Provider business mailing address

7220 W 38TH AVE
WHEAT RIDGE CO
80033-4841
US

V. Phone/Fax

Practice location:
  • Phone: 303-423-6712
  • Fax: 303-423-7206
Mailing address:
  • Phone: 303-423-6712
  • Fax: 303-423-7206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7001-3
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerPROVIDER NUMBER
# 2
Identifier8200146
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerPROVIDER NUMBER
# 3
Identifier08002743
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name: MR. HENRY ALBERT BETETA
Title or Position: OWNER
Credential:
Phone: 303-423-6712