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General NPI Number Information
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NPI Number | 1760998512
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Entity Type | Organization
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Legal Business Name | SAM'S SHOE REPAIR
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Dates
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Enumeration Date | 12/15/2017
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Last Update Date | 12/15/2017
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Provider Practice Location Address
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Address Line | 304 N 3RD ST
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City | MARQUETTE
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State | MI
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Zip | 49855-4224
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Country | US
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Telephone | 906-226-9087
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Fax |
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Provider Business Mailing Address
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Address Line | 304 N 3RD ST
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City | MARQUETTE
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State | MI
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Zip | 49855-4224
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. SAM ROUMANIS
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Credential |
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Telephone | 906-226-9087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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