Provider Demographics
NPI:1295916195
Name:COMFORT ORTHOPEDIC FOOTWARE INC
Entity type:Organization
Organization Name:COMFORT ORTHOPEDIC FOOTWARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUGHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PEDORTHIST
Authorized Official - Phone:317-882-3668
Mailing Address - Street 1:1001 N STATE ROAD 135
Mailing Address - Street 2:SUITE D3
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1348
Mailing Address - Country:US
Mailing Address - Phone:317-882-3668
Mailing Address - Fax:317-882-3700
Practice Address - Street 1:1001 N STATE ROAD 135
Practice Address - Street 2:SUITE D3
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1348
Practice Address - Country:US
Practice Address - Phone:317-882-3668
Practice Address - Fax:317-882-3700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN332BC3200X332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5558010001Medicare NSC