Provider Demographics
NPI:1356461461
Name:FOOTWISE COMFORT SHOES
Entity Type:Organization
Organization Name:FOOTWISE COMFORT SHOES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ORLY
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:615-662-1300
Mailing Address - Street 1:7114 HIGHWAY 70 S
Mailing Address - Street 2:SUITE 109
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-2981
Mailing Address - Country:US
Mailing Address - Phone:615-662-1300
Mailing Address - Fax:615-662-1326
Practice Address - Street 1:7114 HIGHWAY 70 S
Practice Address - Street 2:SUITE 109
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-2981
Practice Address - Country:US
Practice Address - Phone:615-662-1300
Practice Address - Fax:615-662-1326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1544047Medicaid
TN4116958OtherBCBS OF TN
TN1544047Medicaid