Healthcare Provider Details

I. General information

NPI: 1174536031
Provider Name (Legal Business Name): MEDS SHOES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WETUPKA WAY
HERNANDO MS
38632-4420
US

IV. Provider business mailing address

11301 WETUPKA WAY
HERNANDO MS
38632-4420
US

V. Phone/Fax

Practice location:
  • Phone: 662-429-5835
  • Fax: 662-449-0443
Mailing address:
  • Phone: 662-429-5835
  • Fax: 662-449-0443

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. PATRICIA D MOORE
Title or Position: PRESIDENT
Credential:
Phone: 662-429-5835