Provider Demographics
NPI:1659386043
Name:SHOEBOAT, INC.
Entity Type:Organization
Organization Name:SHOEBOAT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAB
Authorized Official - Middle Name:J
Authorized Official - Last Name:HALBERG
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:239-481-3404
Mailing Address - Street 1:9131 COLLEGE PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-5818
Mailing Address - Country:US
Mailing Address - Phone:239-481-3404
Mailing Address - Fax:239-481-6254
Practice Address - Street 1:9131 COLLEGE PKWY STE 120
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-5818
Practice Address - Country:US
Practice Address - Phone:239-481-3404
Practice Address - Fax:239-481-6254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPED 97332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5411710001Medicare ID - Type UnspecifiedNATIONAL CLEARINGHOUSE