Provider Demographics
NPI:1568494516
Name:QUALITY COBBLER INC
Entity Type:Organization
Organization Name:QUALITY COBBLER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:OST
Authorized Official - Phone:563-263-9372
Mailing Address - Street 1:1903 PARK AVE
Mailing Address - Street 2:MUSCATINE MALL
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-5400
Mailing Address - Country:US
Mailing Address - Phone:563-263-9372
Mailing Address - Fax:
Practice Address - Street 1:1903 PARK AVE
Practice Address - Street 2:MUSCATINE MALL
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-5400
Practice Address - Country:US
Practice Address - Phone:563-263-9372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0433763Medicaid