Provider Demographics
NPI:1164715488
Name:SHOE SPECIALISTS OF LAREDO & MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:SHOE SPECIALISTS OF LAREDO & MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-508-7666
Mailing Address - Street 1:1109 N US HIGHWAY 83 STE 2
Mailing Address - Street 2:
Mailing Address - City:ZAPATA
Mailing Address - State:TX
Mailing Address - Zip Code:78076-3521
Mailing Address - Country:US
Mailing Address - Phone:956-508-7666
Mailing Address - Fax:
Practice Address - Street 1:517 SHILOH DR
Practice Address - Street 2:STE4
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6722
Practice Address - Country:US
Practice Address - Phone:956-508-7666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies