Provider Demographics
NPI:1558485987
Name:JOSHUA C ALLISON
Entity Type:Organization
Organization Name:JOSHUA C ALLISON
Other - Org Name:ALLISONS COMFORT SHOES & BOOTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:T
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:615-217-9821
Mailing Address - Street 1:4225 S STATE ROUTE 159
Mailing Address - Street 2:STE 1
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-3231
Mailing Address - Country:US
Mailing Address - Phone:618-288-9297
Mailing Address - Fax:618-288-1260
Practice Address - Street 1:4225 S STATE ROUTE 159
Practice Address - Street 2:STE 1
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-3231
Practice Address - Country:US
Practice Address - Phone:618-288-9297
Practice Address - Fax:618-288-1260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5893060001Medicare NSC