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General NPI Number Information
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NPI Number | 1639238959
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Entity Type | Organization
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Legal Business Name | MACINOS COMFORT SHOES AND ORTHOTICS LTD
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 08/26/2015
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Provider Practice Location Address
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Address Line | 3140 W SYLVANIA AVE
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City | TOLEDO
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State | OH
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Zip | 43613-4133
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Country | US
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Telephone | 419-475-3996
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Fax | 419-475-3644
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Provider Business Mailing Address
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Address Line | 3140 W SYLVANIA AVE
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City | TOLEDO
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State | OH
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Zip | 43613-4133
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Country | US
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Telephone | 419-475-3996
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Fax | 419-475-3644
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Authorized Official
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Title or Position | OWNER
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Name | MR. ANTHONY WILLIAM MACINO
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Credential |
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Telephone | 419-475-3996
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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 |
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License Number State |
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Legacy Identifiers
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Identifier #1
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Identifier Code | 2638186
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Identifier Type | MEDICAID
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Identifier State | OH
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Identifier Issuer |
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 2638186
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Identifier Type | MEDICAID
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Identifier State | OH
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Identifier Issuer |
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