Healthcare Provider Details

I. General information

NPI: 1154426153
Provider Name (Legal Business Name): MSA SHOE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5929 MAYFIELD ROAD
CLEVELAND OH
44124-2902
US

IV. Provider business mailing address

5929 MAYFIELD ROAD
CLEVELAND OH
44124-2902
US

V. Phone/Fax

Practice location:
  • Phone: 440-442-1443
  • Fax: 440-442-1443
Mailing address:
  • Phone: 440-442-1443
  • Fax: 440-442-1443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number18448670
License Number StateOH

VIII. Authorized Official

Name: MR. SION KHAIMOV
Title or Position: OWNER
Credential:
Phone: 440-442-1443