Provider Demographics
NPI:1881871077
Name:CAROL'S SPECIALTY SHOPPE
Entity type:Organization
Organization Name:CAROL'S SPECIALTY SHOPPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:N
Authorized Official - Last Name:MAURER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-273-5055
Mailing Address - Street 1:809 E EVERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7928
Mailing Address - Country:US
Mailing Address - Phone:717-273-5055
Mailing Address - Fax:
Practice Address - Street 1:809 E EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7928
Practice Address - Country:US
Practice Address - Phone:717-273-5055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA600003485335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000212306OtherHIGHMARK B S
PA50017682OtherBAPITAL BLUE CROSS
PA0383900001Medicare NSC