Provider Demographics
NPI:1902159858
Name:SHOE MATE
Entity Type:Organization
Organization Name:SHOE MATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEAD
Authorized Official - Suffix:
Authorized Official - Credentials:PEDORTHIST
Authorized Official - Phone:515-205-1811
Mailing Address - Street 1:6750 WESTOWN PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-7717
Mailing Address - Country:US
Mailing Address - Phone:515-205-8111
Mailing Address - Fax:515-453-8429
Practice Address - Street 1:1011 88TH ST
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-5857
Practice Address - Country:US
Practice Address - Phone:515-205-1811
Practice Address - Fax:515-453-8429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier