MEDICARE: SHOE COMFORT INC

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		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M2772	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1578671541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHOE COMFORT INC

Provider Business Mailing Address
First Line	:	6632 RIDGE RD
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-6837
Country	:	US
Telephone Number	:	727-842-7693
Fax Number	:	727-842-8677

Provider Business Practice Location Address
First Line	:	6632 RIDGE RD
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-6837
Country	:	US
Telephone Number	:	727-842-7693
Fax Number	:	727-842-8677

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN HNILICA
Credential	:
Telephone Number	:	727-842-7693

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	08/22/2020

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Directions to “SHOE COMFORT INC ” Practice Location

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