Provider Demographics
NPI:1487848206
Name:BLACK EYED PEAS INVESTMENTS, INC.
Entity Type:Organization
Organization Name:BLACK EYED PEAS INVESTMENTS, INC.
Other - Org Name:FOOT SOLUTIONS.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHEPHERD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BEASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:C PED
Authorized Official - Phone:239-458-3360
Mailing Address - Street 1:2311 SANTA BARBARA BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-4394
Mailing Address - Country:US
Mailing Address - Phone:239-458-3360
Mailing Address - Fax:239-242-1095
Practice Address - Street 1:2311 SANTA BARBARA BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-4394
Practice Address - Country:US
Practice Address - Phone:239-458-3360
Practice Address - Fax:239-242-1095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPED 129332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5947450001Medicare NSC