Provider Demographics
NPI:1568561652
Name:THE DIABETIC SHOE & SERVICE CLINIC
Entity Type:Organization
Organization Name:THE DIABETIC SHOE & SERVICE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-287-4280
Mailing Address - Street 1:101 S JOHN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BLACKSBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29702-1559
Mailing Address - Country:US
Mailing Address - Phone:864-839-1800
Mailing Address - Fax:
Practice Address - Street 1:101 S JOHN ST
Practice Address - Street 2:SUITE B
Practice Address - City:BLACKSBURG
Practice Address - State:SC
Practice Address - Zip Code:29702-1559
Practice Address - Country:US
Practice Address - Phone:864-839-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies