MEDICARE: H & H SHOE REPAIR & PEDORTHIC FACILITY

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	A221772	NC

General Provider Information

NPI Number	:	1194726265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	H & H SHOE REPAIR & PEDORTHIC FACILITY

Provider Business Mailing Address
First Line	:	518 DANIELS ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27605-1317
Country	:	US
Telephone Number	:	919-828-2988
Fax Number	:

Provider Business Practice Location Address
First Line	:	518 DANIELS ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27605-1317
Country	:	US
Telephone Number	:	919-828-2988
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MS. LIZ ANN CHILES
Credential	:	CERTIFIED PEDORTHIST
Telephone Number	:	919-828-2988

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/02/2008

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