Provider Demographics
NPI:1497713663
Name:MCLELLAND SHOES INC
Entity Type:Organization
Organization Name:MCLELLAND SHOES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:GODFREY
Authorized Official - Last Name:MCLELLAND
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPED
Authorized Official - Phone:704-873-7935
Mailing Address - Street 1:119 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-5257
Mailing Address - Country:US
Mailing Address - Phone:704-873-7935
Mailing Address - Fax:704-873-7943
Practice Address - Street 1:119 W BROAD ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-5257
Practice Address - Country:US
Practice Address - Phone:704-873-7935
Practice Address - Fax:704-873-7943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0670650001Medicare NSC