=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639137755
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHOE AND FOOT INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 MAPLE ST
-----------------------------------------------------
City | STONEHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02180-3143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-933-0602
-----------------------------------------------------
Fax | 781-497-2926
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 MAPLE ST
-----------------------------------------------------
City | STONEHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02180-3143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-933-0602
-----------------------------------------------------
Fax | 781-497-2926
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. PETER BOZOVIC
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 781-933-0602
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------