MEDICARE: MCMAHAN SHOES, 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	335E00000X	Prosthetic/Orthotic Supplier	435	TX

General Provider Information

NPI Number	:	1780707786
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCMAHAN SHOES, INC.

Provider Business Mailing Address
First Line	:	3903 GASTON AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-1512
Country	:	US
Telephone Number	:	214-827-7921
Fax Number	:	214-827-7926

Provider Business Practice Location Address
First Line	:	3903 GASTON AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-1512
Country	:	US
Telephone Number	:	214-827-7921
Fax Number	:	214-827-7926

Authorized Official
Title or Position	:	CEO
Name	:	MR. CURTIS P MCMAHAN
Credential	:	CERTIFIED PEDORTHIST
Telephone Number	:	214-827-7921

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	08/22/2020

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