MEDICARE: SHOE AND FOOT 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	800466	OTHER	MA	TUFTS
2	281754	OTHER	MA	BLUE CROSS BLUE SHIELD
3	702226	OTHER	MA	HARVARD PILGRIM HC
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639137755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHOE AND FOOT INC

Provider Business Mailing Address
First Line	:	100 MAPLE ST
Second Line	:
City	:	STONEHAM
State	:	MA
Zip	:	02180-3143
Country	:	US
Telephone Number	:	781-933-0602
Fax Number	:	781-497-2926

Provider Business Practice Location Address
First Line	:	100 MAPLE ST
Second Line	:
City	:	STONEHAM
State	:	MA
Zip	:	02180-3143
Country	:	US
Telephone Number	:	781-933-0602
Fax Number	:	781-497-2926

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PETER BOZOVIC
Credential	:
Telephone Number	:	781-933-0602

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	08/22/2020

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Directions to “SHOE AND FOOT INC ” Practice Location

Language	Start Address	Practice Location

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