Provider Demographics
NPI:1023188190
Name:VERNON POWELL SHOE COMPANY
Entity Type:Organization
Organization Name:VERNON POWELL SHOE COMPANY
Other - Org Name:PEDORTHICS DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:410-749-4561
Mailing Address - Street 1:2401 E NAYLOR MILL RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-2101
Mailing Address - Country:US
Mailing Address - Phone:410-749-4561
Mailing Address - Fax:410-749-8453
Practice Address - Street 1:2401 E NAYLOR MILL RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-2101
Practice Address - Country:US
Practice Address - Phone:410-749-4561
Practice Address - Fax:410-749-8453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier