Provider Demographics
NPI:1639267586
Name:COMFORT SHOE SPECIALISTS
Entity Type:Organization
Organization Name:COMFORT SHOE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:314-822-3300
Mailing Address - Street 1:11693 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-4613
Mailing Address - Country:US
Mailing Address - Phone:314-822-3300
Mailing Address - Fax:314-822-1082
Practice Address - Street 1:11693 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-4613
Practice Address - Country:US
Practice Address - Phone:314-822-3300
Practice Address - Fax:314-822-1082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
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
OH1023861OtherUHC ANCILLARY CARE MANAGE
MODEPT. OF LABOR/OWCPOtherGOVENRMENT WORK COMP.
OH1023861OtherUHC ANCILLARY CARE MANAGE
MODEPT. OF LABOR/OWCPOtherGOVENRMENT WORK COMP.