Provider Demographics
NPI:1861830614
Name:PAMS SHOES & PEDORTHICS
Entity Type:Organization
Organization Name:PAMS SHOES & PEDORTHICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT, C. PED.
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:C PED
Authorized Official - Phone:479-890-5933
Mailing Address - Street 1:805 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-5249
Mailing Address - Country:US
Mailing Address - Phone:479-890-5933
Mailing Address - Fax:479-890-9373
Practice Address - Street 1:805 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-5249
Practice Address - Country:US
Practice Address - Phone:479-890-5933
Practice Address - Fax:479-890-9373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROPP00035332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies