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General NPI Number Information
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NPI Number | 1154426153
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Entity Type | Organization
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Legal Business Name | MSA SHOE SERVICES
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5929 MAYFIELD ROAD
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City | CLEVELAND
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State | OH
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Zip | 44124-2902
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Country | US
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Telephone | 440-442-1443
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Fax | 440-442-1443
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Provider Business Mailing Address
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Address Line | 5929 MAYFIELD ROAD
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City | CLEVELAND
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State | OH
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Zip | 44124-2902
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Country | US
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Telephone | 440-442-1443
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Fax | 440-442-1443
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Authorized Official
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Title or Position | OWNER
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Name | MR. SION KHAIMOV
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Credential |
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Telephone | 440-442-1443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 18448670
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License Number State | OH
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