Healthcare Provider Details

I. General information

NPI: 1366487167
Provider Name (Legal Business Name): GENE'S SPECIALTY FOOTWEAR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 10/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 N MAIN ST
SAINT CHARLES MO
63301-2827
US

IV. Provider business mailing address

126 N MAIN ST
SAINT CHARLES MO
63301-2827
US

V. Phone/Fax

Practice location:
  • Phone: 636-946-1652
  • Fax: 636-940-7463
Mailing address:
  • Phone: 636-946-1652
  • Fax: 636-940-7463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MS. MARJORIE GAINES
Title or Position: SECRETARY/TREASURER
Credential: C. PED
Phone: 636-946-1652