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General NPI Number Information
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NPI Number | 1538211784
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Entity Type | Organization
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Legal Business Name | MR. SHANE'S. INC.
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 09/29/2008
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Provider Practice Location Address
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Address Line | 17735 15TH AVE NE
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City | SHORELINE
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State | WA
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Zip | 98155-3803
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Country | US
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Telephone | 206-364-1322
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Fax | 206-365-2074
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Provider Business Mailing Address
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Address Line | 17735 15TH AVE NE
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City | SHORELINE
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State | WA
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Zip | 98155-3803
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Country | US
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Telephone | 206-364-1322
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Fax | 206-365-2074
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHANE G. HAYES
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Credential | CERTIFIED PEDORTHIST
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Telephone | 206-364-1322
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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 | 600559120
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License Number State | WA
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