Provider Demographics
NPI:1326105529
Name:COMFORTFIT FOOTWEAR LLC
Entity Type:Organization
Organization Name:COMFORTFIT FOOTWEAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRONSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:931-528-1331
Mailing Address - Street 1:560 S JEFFERSON AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-4036
Mailing Address - Country:US
Mailing Address - Phone:931-526-7052
Mailing Address - Fax:931-528-5903
Practice Address - Street 1:560 S JEFFERSON AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4036
Practice Address - Country:US
Practice Address - Phone:931-526-7052
Practice Address - Fax:931-528-5903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
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
TN5522450001Medicare NSC