Provider Demographics
NPI:1477605566
Name:MEDIC FOOTWEAR INC
Entity Type:Organization
Organization Name:MEDIC FOOTWEAR INC
Other - Org Name:NOBILE SHOES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMILIO
Authorized Official - Middle Name:C
Authorized Official - Last Name:BADARO
Authorized Official - Suffix:
Authorized Official - Credentials:LIC CPED
Authorized Official - Phone:561-842-7400
Mailing Address - Street 1:420 US HIGHWAY 1
Mailing Address - Street 2:SUITE 8
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-5520
Mailing Address - Country:US
Mailing Address - Phone:561-842-7400
Mailing Address - Fax:561-842-5151
Practice Address - Street 1:420 US HIGHWAY 1
Practice Address - Street 2:SUITE 8
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-5520
Practice Address - Country:US
Practice Address - Phone:561-842-7400
Practice Address - Fax:561-842-5151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPED106335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4259590001Medicare NSC