Healthcare Provider Details

I. General information

NPI: 1144495474
Provider Name (Legal Business Name): SHOE HEEL MEDICAL SUPPLY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 04/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 N PATTERSON ST
MAXTON NC
28364-1734
US

IV. Provider business mailing address

109 N PATTERSON ST
MAXTON NC
28364-1734
US

V. Phone/Fax

Practice location:
  • Phone: 910-844-6000
  • Fax: 910-844-6004
Mailing address:
  • Phone: 910-844-6000
  • Fax: 910-844-6004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNC

VIII. Authorized Official

Name: MR. GREGORY LOWERY
Title or Position: MANAGER/OWNER
Credential:
Phone: 910-844-6000