MEDICARE: MSA SHOE SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	18448670	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154426153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MSA SHOE SERVICES

Provider Business Mailing Address
First Line	:	5929 MAYFIELD ROAD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44124-2902
Country	:	US
Telephone Number	:	440-442-1443
Fax Number	:	440-442-1443

Provider Business Practice Location Address
First Line	:	5929 MAYFIELD ROAD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44124-2902
Country	:	US
Telephone Number	:	440-442-1443
Fax Number	:	440-442-1443

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SION KHAIMOV
Credential	:
Telephone Number	:	440-442-1443

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	08/22/2020

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Directions to “MSA SHOE SERVICES ” Practice Location

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