Provider Demographics
NPI:1861672925
Name:SAFETY PLUS FOOTWEAR CENTER, LLC
Entity Type:Organization
Organization Name:SAFETY PLUS FOOTWEAR CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MEBANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-588-2335
Mailing Address - Street 1:7534 GRANBY ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-3427
Mailing Address - Country:US
Mailing Address - Phone:757-588-2335
Mailing Address - Fax:757-588-2241
Practice Address - Street 1:7534 GRANBY ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-3427
Practice Address - Country:US
Practice Address - Phone:757-588-2335
Practice Address - Fax:757-588-2241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6047650001Medicare NSC