Provider Demographics
NPI:1508089954
Name:THE FOOTWEAR COMPANY LLC
Entity Type:Organization
Organization Name:THE FOOTWEAR COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:E
Authorized Official - Last Name:DENTON
Authorized Official - Suffix:
Authorized Official - Credentials:PEDORTHIST
Authorized Official - Phone:386-447-0560
Mailing Address - Street 1:3 CYPRESS BRANCH WAY
Mailing Address - Street 2:SUITE 108A
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-8409
Mailing Address - Country:US
Mailing Address - Phone:386-447-0560
Mailing Address - Fax:386-447-0522
Practice Address - Street 1:3 CYPRESS BRANCH WAY
Practice Address - Street 2:SUITE 108A
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-8409
Practice Address - Country:US
Practice Address - Phone:336-446-4226
Practice Address - Fax:336-446-4206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5975420001Medicare NSC