Provider Demographics
NPI:1891882015
Name:SHOE REPAIR PLUS, LLC
Entity Type:Organization
Organization Name:SHOE REPAIR PLUS, LLC
Other - Org Name:SHOE REPAIR PLUS, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:FLOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:843-662-9930
Mailing Address - Street 1:421 S IRBY ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4709
Mailing Address - Country:US
Mailing Address - Phone:843-662-9930
Mailing Address - Fax:
Practice Address - Street 1:421 S IRBY ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4709
Practice Address - Country:US
Practice Address - Phone:843-662-9930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-08
Last Update Date:2007-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies