Provider Demographics
NPI:1922544659
Name:THE SHOE BOX
Entity Type:Organization
Organization Name:THE SHOE BOX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WELDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-877-9174
Mailing Address - Street 1:2820 S MONROE ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-6952
Mailing Address - Country:US
Mailing Address - Phone:850-877-9174
Mailing Address - Fax:850-877-9203
Practice Address - Street 1:2820 S MONROE ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-6952
Practice Address - Country:US
Practice Address - Phone:850-877-9174
Practice Address - Fax:850-877-9203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4780120174684332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies