Provider Demographics
NPI:1740337427
Name:GEO ALLEN SHOES INC
Entity type:Organization
Organization Name:GEO ALLEN SHOES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DALLAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:708-388-8570
Mailing Address - Street 1:13003 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-2406
Mailing Address - Country:US
Mailing Address - Phone:708-388-8570
Mailing Address - Fax:708-824-2606
Practice Address - Street 1:13003 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2406
Practice Address - Country:US
Practice Address - Phone:708-388-8570
Practice Address - Fax:708-824-2606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL212-000021332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0484170001Medicare NSC