Provider Demographics
NPI:1316021660
Name:ADC SHOES, INC.
Entity Type:Organization
Organization Name:ADC SHOES, INC.
Other - Org Name:COMFORT SHOES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MASOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:HAKIMZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:413-540-0900
Mailing Address - Street 1:15 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-1422
Mailing Address - Country:US
Mailing Address - Phone:413-540-0900
Mailing Address - Fax:413-540-0900
Practice Address - Street 1:15 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-1422
Practice Address - Country:US
Practice Address - Phone:413-540-0900
Practice Address - Fax:413-540-0900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1318400001Medicare NSC