Provider Demographics
NPI:1750317095
Name:SHOE FITTERS
Entity Type:Organization
Organization Name:SHOE FITTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:BETETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-423-6712
Mailing Address - Street 1:7220 W 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4841
Mailing Address - Country:US
Mailing Address - Phone:303-423-6712
Mailing Address - Fax:303-423-7206
Practice Address - Street 1:7220 W 38TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4841
Practice Address - Country:US
Practice Address - Phone:303-423-6712
Practice Address - Fax:303-423-7206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO7001-3OtherPROVIDER NUMBER
CO8200146OtherPROVIDER NUMBER
CO08002743Medicaid
CO0945680001Medicare NSC