Healthcare Provider Details

I. General information

NPI: 1457363327
Provider Name (Legal Business Name): SHOES N STUFF INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2133 ROCKFORD ST STE 500
MOUNT AIRY NC
27030-6667
US

IV. Provider business mailing address

2133 ROCKFORD ST STE 500
MOUNT AIRY NC
27030-6667
US

V. Phone/Fax

Practice location:
  • Phone: 336-789-8494
  • Fax: 336-789-8561
Mailing address:
  • Phone: 336-789-8494
  • Fax: 336-789-8561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: RONALD A KIRKMAN SR.
Title or Position: OWNER
Credential:
Phone: 336-789-8494