Provider Demographics
NPI:1043296908
Name:FLETCHERS SHOES INC
Entity Type:Organization
Organization Name:FLETCHERS SHOES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GRADY
Authorized Official - Middle Name:B
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:PEDORTHIST
Authorized Official - Phone:615-790-3610
Mailing Address - Street 1:2221 HILLSBORO RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37069-6200
Mailing Address - Country:US
Mailing Address - Phone:615-790-3610
Mailing Address - Fax:615-790-2721
Practice Address - Street 1:2221 HILLSBORO RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37069-6200
Practice Address - Country:US
Practice Address - Phone:615-790-3610
Practice Address - Fax:615-790-2721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1240220001Medicare ID - Type Unspecified