Provider Demographics
NPI:1063843977
Name:M&C SIGNATURE, LLC
Entity Type:Organization
Organization Name:M&C SIGNATURE, LLC
Other - Org Name:COMFORT ZONE SHOES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-721-5217
Mailing Address - Street 1:1474 W GRANADA BLVD
Mailing Address - Street 2:SUITE 475
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-9187
Mailing Address - Country:US
Mailing Address - Phone:386-677-7011
Mailing Address - Fax:386-677-7075
Practice Address - Street 1:1474 W GRANADA BLVD
Practice Address - Street 2:SUITE 475
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-9187
Practice Address - Country:US
Practice Address - Phone:386-677-7011
Practice Address - Fax:386-677-7075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies