Provider Demographics
NPI:1902986748
Name:FEET 1ST SHOES, INC.
Entity Type:Organization
Organization Name:FEET 1ST SHOES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:
Authorized Official - Last Name:NIELD
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:904-731-3338
Mailing Address - Street 1:8081 PHILIPS HWY STE 4
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7443
Mailing Address - Country:US
Mailing Address - Phone:904-731-3338
Mailing Address - Fax:904-731-3348
Practice Address - Street 1:8081 PHILIPS HWY
Practice Address - Street 2:SUITE 5
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7464
Practice Address - Country:US
Practice Address - Phone:904-731-3338
Practice Address - Fax:904-731-3348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPED69332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM2604OtherBLUE CROSS BLUE SHIELD
=========OtherTRICARE
FLM2604OtherBLUE CROSS BLUE SHIELD