Provider Demographics
NPI:1518394824
Name:AMERICAN ORTHOPAEDICS & DIABETIC SHOES INC
Entity Type:Organization
Organization Name:AMERICAN ORTHOPAEDICS & DIABETIC SHOES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:LOF
Authorized Official - Phone:239-541-9480
Mailing Address - Street 1:4706 CHIQUITA BLVD S
Mailing Address - Street 2:SUITE 200 PMB 408
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-6321
Mailing Address - Country:US
Mailing Address - Phone:239-541-9480
Mailing Address - Fax:239-471-7311
Practice Address - Street 1:621 CAPE CORAL PKWY E
Practice Address - Street 2:SUITE 1
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-7515
Practice Address - Country:US
Practice Address - Phone:239-541-9480
Practice Address - Fax:239-471-7311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-01
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLORF119335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier