Provider Demographics
NPI:1356580427
Name:BROWN'S SHOE FIT CO. #58
Entity type:Organization
Organization Name:BROWN'S SHOE FIT CO. #58
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:TIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-665-4062
Mailing Address - Street 1:1716 N BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-2485
Mailing Address - Country:US
Mailing Address - Phone:660-665-4062
Mailing Address - Fax:660-665-4062
Practice Address - Street 1:1716 N BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-2485
Practice Address - Country:US
Practice Address - Phone:660-665-4062
Practice Address - Fax:660-665-4062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies