Provider Demographics
NPI:1770754996
Name:YORK BOOT -N- REPAIR INC
Entity type:Organization
Organization Name:YORK BOOT -N- REPAIR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:OBERMIER
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:402-362-5063
Mailing Address - Street 1:514 N GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:NE
Mailing Address - Zip Code:68467-3039
Mailing Address - Country:US
Mailing Address - Phone:402-362-5063
Mailing Address - Fax:
Practice Address - Street 1:514 N GRANT AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467-3039
Practice Address - Country:US
Practice Address - Phone:402-362-5063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE6126240001Medicare NSC