Provider Demographics
NPI:1477725869
Name:COMFORT PLUS SHOE CENTER, INC.
Entity Type:Organization
Organization Name:COMFORT PLUS SHOE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CPED
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MANNINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-392-2952
Mailing Address - Street 1:535 N 155TH PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-3775
Mailing Address - Country:US
Mailing Address - Phone:402-392-2952
Mailing Address - Fax:402-392-1761
Practice Address - Street 1:535 N 155TH PLZ
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-3775
Practice Address - Country:US
Practice Address - Phone:402-392-2952
Practice Address - Fax:402-392-1761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7077181332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025318500Medicaid
NE09980OtherBLUE CROSS BLUE SHIELD
IA0939116Medicaid
NE09980OtherBLUE CROSS BLUE SHIELD