Provider Demographics
NPI:1639482797
Name:SHOE SPECIALISTS OF LAREDO & MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:SHOE SPECIALISTS OF LAREDO & MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-740-4017
Mailing Address - Street 1:205 W VILLAGE BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-2261
Mailing Address - Country:US
Mailing Address - Phone:956-401-9008
Mailing Address - Fax:
Practice Address - Street 1:205 W VILLAGE BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2261
Practice Address - Country:US
Practice Address - Phone:956-401-9008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies