Provider Demographics
NPI:1639137755
Name:SHOE AND FOOT INC
Entity Type:Organization
Organization Name:SHOE AND FOOT INC
Other - Org Name:BOND SHOES AND PEDORTHICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BOZOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-933-0602
Mailing Address - Street 1:100 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3143
Mailing Address - Country:US
Mailing Address - Phone:781-933-0602
Mailing Address - Fax:781-497-2926
Practice Address - Street 1:100 MAPLE ST
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3143
Practice Address - Country:US
Practice Address - Phone:781-933-0602
Practice Address - Fax:781-497-2926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA800466OtherTUFTS
MA281754OtherBLUE CROSS BLUE SHIELD
MA702226OtherHARVARD PILGRIM HC
MA1538837Medicaid
MA702226OtherHARVARD PILGRIM HC