Provider Demographics
NPI:1740799170
Name:RICHMOND SHOE COMPANY LLC
Entity Type:Organization
Organization Name:RICHMOND SHOE COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTANNIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-259-1954
Mailing Address - Street 1:10 N 7TH ST STE 508
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-3089
Mailing Address - Country:US
Mailing Address - Phone:765-259-1954
Mailing Address - Fax:
Practice Address - Street 1:10 N 7TH ST STE 508
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-3089
Practice Address - Country:US
Practice Address - Phone:765-259-1954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies