Provider Demographics
NPI:1225164312
Name:AMERICAN DIABETIC SHOE ALLIANCES, INC
Entity Type:Organization
Organization Name:AMERICAN DIABETIC SHOE ALLIANCES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BETHANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALGIE
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED PEDORTHIST
Authorized Official - Phone:941-235-7463
Mailing Address - Street 1:PO BOX 494983
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33949-4983
Mailing Address - Country:US
Mailing Address - Phone:941-235-7463
Mailing Address - Fax:941-625-6898
Practice Address - Street 1:3129 TAMIAMI TRL
Practice Address - Street 2:SUITE E
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8010
Practice Address - Country:US
Practice Address - Phone:941-235-7463
Practice Address - Fax:941-625-6898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5572240001Medicare ID - Type Unspecified