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General NPI Number Information
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NPI Number | 1780868208
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Entity Type | Organization
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Legal Business Name | VANDYGRIFF SHOES
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 179 WOODELL ST
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City | CLINTON
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State | AR
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Zip | 72031-6929
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Country | US
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Telephone | 501-745-4060
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Fax | 501-745-4012
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Provider Business Mailing Address
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Address Line | 179 WOODELL ST
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City | CLINTON
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State | AR
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Zip | 72031-6929
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Country | US
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Telephone | 501-745-4060
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Fax | 501-745-4012
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Authorized Official
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Title or Position | OWNER
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Name | MR. IRWIN R VANLDYGRIFF
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Credential |
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Telephone | 501-745-4060
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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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