Provider Demographics
NPI:1275796435
Name:SHOE MARKET SAMPLES INC
Entity Type:Organization
Organization Name:SHOE MARKET SAMPLES INC
Other - Org Name:THE SHOE MARKET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-632-1188
Mailing Address - Street 1:4624 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-1232
Mailing Address - Country:US
Mailing Address - Phone:336-632-1188
Mailing Address - Fax:336-632-9011
Practice Address - Street 1:4624 W MARKET ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1232
Practice Address - Country:US
Practice Address - Phone:336-632-1188
Practice Address - Fax:336-632-9011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332BC3200X332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4410810001Medicare NSC