Provost Shoes

LBN: Provost Shoes
Provost Shoes is an health care organization with primary practice located at 25 Laurel Mall , Hazleton PA 18202-1201. The organization recently has only one registered license in Suppliers / Durable Medical Equipment & Medical Supplies, which is considered as the primary health care specialty. Provost Shoes can be contacted via phone (570) 455-7704, or through Provost, John M via phone (570) 455-7704.

Contact Information

Primary practice address
25 Laurel Mall Hazleton PA 18202-1201
Phone: (570) 455-7704
Fax: (570) 455-7704
Website:
Map and Directions
Authorized official contact:
Name: Provost, John M C. PED
Phone: (570) 455-7704

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Durable Medical Equipment & Medical Supplies 332B00000X 4244780002 Pennsylvania

Profile Details

NPI number 1447431945
LBN Legal business name Provost Shoes
DBA Doing business as
Authorized official Provost, John M C. PED
Entity Organization
Organization subpart 1 No
Enumeration date Nov 26th, 2007
Last updated Dec 5th, 2007 - about 18 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1447431945 NPPES
Other A08009797 MEDICARE EDI BILLING NUMB

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