Provider Demographics
NPI:1457363327
Name:SHOES N STUFF INC
Entity type:Organization
Organization Name:SHOES N STUFF INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIRKMAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:336-789-8494
Mailing Address - Street 1:2133 ROCKFORD ST STE 500
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-6667
Mailing Address - Country:US
Mailing Address - Phone:336-789-8494
Mailing Address - Fax:336-789-8561
Practice Address - Street 1:2133 ROCKFORD ST STE 500
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-6667
Practice Address - Country:US
Practice Address - Phone:336-789-8494
Practice Address - Fax:336-789-8561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
335E00000X
NC332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7704168Medicaid
NC=========OtherTAX ID NUMBER
4242750001Medicare NSC