Provider Demographics
NPI:1356492854
Name:MCMAHAN SHOES, INC
Entity Type:Organization
Organization Name:MCMAHAN SHOES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:N
Authorized Official - Last Name:PSILLAS
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED PEDORTHIST
Authorized Official - Phone:864-585-1579
Mailing Address - Street 1:PO BOX 6142
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-6142
Mailing Address - Country:US
Mailing Address - Phone:864-585-1579
Mailing Address - Fax:864-597-1071
Practice Address - Street 1:249 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-5135
Practice Address - Country:US
Practice Address - Phone:864-585-1579
Practice Address - Fax:864-597-1071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1206900001Medicare ID - Type UnspecifiedDURABLE MEDICAL EQUIPMENT