Provider Demographics
NPI:1518157387
Name:PARK SHOES, INC.
Entity Type:Organization
Organization Name:PARK SHOES, INC.
Other - Org Name:VILLAGE BOOTERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SCHUEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-746-3536
Mailing Address - Street 1:245 S. US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-2701
Mailing Address - Country:US
Mailing Address - Phone:772-746-3536
Mailing Address - Fax:772-744-7851
Practice Address - Street 1:245 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-2701
Practice Address - Country:US
Practice Address - Phone:772-746-3536
Practice Address - Fax:772-744-7851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPED73332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies