Provider Demographics
NPI:1477613842
Name:SAAGERS SHOE SHOP INC
Entity type:Organization
Organization Name:SAAGERS SHOE SHOP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRUSTEE
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SAAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-938-5162
Mailing Address - Street 1:613 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILTON FREEWATER
Mailing Address - State:OR
Mailing Address - Zip Code:97862-1727
Mailing Address - Country:US
Mailing Address - Phone:541-938-5162
Mailing Address - Fax:541-938-3148
Practice Address - Street 1:613 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MILTON FREEWATER
Practice Address - State:OR
Practice Address - Zip Code:97862-1727
Practice Address - Country:US
Practice Address - Phone:541-938-5162
Practice Address - Fax:541-938-3148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR167767Medicaid
WA82828OtherLABOR & INDUSTRIES
WA9021379Medicaid
WA9021379Medicaid