Provider Demographics
NPI:1942296975
Name:ROSIE'S COMFORT SHOES, INC.
Entity Type:Organization
Organization Name:ROSIE'S COMFORT SHOES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CPED
Authorized Official - Prefix:
Authorized Official - First Name:ANGELINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-271-1902
Mailing Address - Street 1:327 MILL ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-1901
Mailing Address - Country:US
Mailing Address - Phone:570-271-1902
Mailing Address - Fax:570-271-1923
Practice Address - Street 1:327 MILL ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-1901
Practice Address - Country:US
Practice Address - Phone:570-271-1902
Practice Address - Fax:570-271-1923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA80329719332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA43554OtherGEISINGER ID NUMBER
PA814208OtherFIRST PRIORITY HEALTH
PA50005229OtherCAPITAL BLUE CROSS
PA237583OtherHIGHMARK BLUE SHIELD
PA50005229OtherCAPITAL BLUE CROSS