Provider Demographics
NPI:1205874914
Name:THERAPEUTIC SHOES INC
Entity type:Organization
Organization Name:THERAPEUTIC SHOES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:CALL
Authorized Official - Suffix:III
Authorized Official - Credentials:DPM
Authorized Official - Phone:208-524-1995
Mailing Address - Street 1:718 BEULAHS LANE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401
Mailing Address - Country:US
Mailing Address - Phone:208-524-1995
Mailing Address - Fax:208-524-1995
Practice Address - Street 1:718 BEULAHS LANE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401
Practice Address - Country:US
Practice Address - Phone:208-524-1995
Practice Address - Fax:208-524-1995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP085213E00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P0854OtherBC
ID1350425Medicaid
82505OtherANTHEM
0505110001Medicare ID - Type Unspecified
P0854OtherBC
T44250Medicare UPIN