Provider Demographics
NPI:1548569676
Name:EASY FEET LLC
Entity Type:Organization
Organization Name:EASY FEET LLC
Other - Org Name:EASY FEET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:G
Authorized Official - Last Name:ROSAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CFNC, CFS
Authorized Official - Phone:662-283-8796
Mailing Address - Street 1:121 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MS
Mailing Address - Zip Code:38967-2239
Mailing Address - Country:US
Mailing Address - Phone:662-283-8796
Mailing Address - Fax:
Practice Address - Street 1:121 N FRONT ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MS
Practice Address - Zip Code:38967-2239
Practice Address - Country:US
Practice Address - Phone:662-283-8796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08872/11.1332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS=========OtherF.E.I.N.
MS6654840001Medicare NSC