Provider Demographics
NPI:1558741934
Name:HAPPY FEET CUSTOM SHOES AND MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:HAPPY FEET CUSTOM SHOES AND MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CORNELIUS
Authorized Official - Middle Name:B
Authorized Official - Last Name:YANCY
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:281-901-8895
Mailing Address - Street 1:7909 S SAM HOUSTON PKWY E
Mailing Address - Street 2:1112
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77075-4780
Mailing Address - Country:US
Mailing Address - Phone:281-901-8895
Mailing Address - Fax:
Practice Address - Street 1:7909 S SAM HOUSTON PKWY E
Practice Address - Street 2:1112
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77075-4780
Practice Address - Country:US
Practice Address - Phone:281-901-8895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment