Provider Demographics
NPI:1245416692
Name:FIGTREE DME
Entity Type:Organization
Organization Name:FIGTREE DME
Other - Org Name:MR. SHOES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:V
Authorized Official - Last Name:FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:CFTO
Authorized Official - Phone:270-926-2999
Mailing Address - Street 1:608 FREDERICA ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-3016
Mailing Address - Country:US
Mailing Address - Phone:270-926-2999
Mailing Address - Fax:270-686-3669
Practice Address - Street 1:608 FREDERICA ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-3016
Practice Address - Country:US
Practice Address - Phone:270-926-2999
Practice Address - Fax:270-686-3669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6090080001Medicare NSC