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General NPI Number Information
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NPI Number | 1861830614
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Entity Type | Organization
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Legal Business Name | PAMS SHOES & PEDORTHICS
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Dates
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Enumeration Date | 06/13/2013
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Last Update Date | 07/02/2013
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Provider Practice Location Address
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Address Line | 805 E MAIN ST
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-5249
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Country | US
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Telephone | 479-890-5933
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Fax | 479-890-9373
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Provider Business Mailing Address
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Address Line | 805 E MAIN ST
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-5249
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Country | US
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Telephone | 479-890-5933
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Fax | 479-890-9373
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Authorized Official
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Title or Position | OWNER, PRESIDENT, C. PED.
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Name | MRS. PAMELA LYNN COOK
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Credential | C. PED.
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Telephone | 479-890-5933
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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 | OPP00035
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License Number State | AR
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