Provider Demographics
NPI:1639238959
Name:MACINOS COMFORT SHOES AND ORTHOTICS LTD
Entity Type:Organization
Organization Name:MACINOS COMFORT SHOES AND ORTHOTICS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MACINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-475-3996
Mailing Address - Street 1:3140 W SYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-4133
Mailing Address - Country:US
Mailing Address - Phone:419-475-3996
Mailing Address - Fax:419-475-3644
Practice Address - Street 1:3140 W SYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-4133
Practice Address - Country:US
Practice Address - Phone:419-475-3996
Practice Address - Fax:419-475-3644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2638186Medicaid
OH5542680001Medicare ID - Type Unspecified