Provider Demographics
NPI:1821273749
Name:CAMPANIS SHOE STORE & REPAIR
Entity Type:Organization
Organization Name:CAMPANIS SHOE STORE & REPAIR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDORTHIC ORTHITIST
Authorized Official - Prefix:
Authorized Official - First Name:DINO
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPANIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-355-1806
Mailing Address - Street 1:148 S ALLEGHENY ST
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823-1958
Mailing Address - Country:US
Mailing Address - Phone:814-355-1806
Mailing Address - Fax:
Practice Address - Street 1:148 S ALLEGHENY ST
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-1958
Practice Address - Country:US
Practice Address - Phone:814-355-1806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50009410OtherCAPITAL BLUE CROSS PPO
PA269781OtherHEALTH AMERICA
PA50009410OtherCAPITAL BLUE CROSS PPO