Provider Demographics
NPI:1144495474
Name:SHOE HEEL MEDICAL SUPPLY INC.
Entity type:Organization
Organization Name:SHOE HEEL MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-844-6000
Mailing Address - Street 1:109 N PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:MAXTON
Mailing Address - State:NC
Mailing Address - Zip Code:28364-1734
Mailing Address - Country:US
Mailing Address - Phone:910-844-6000
Mailing Address - Fax:910-844-6004
Practice Address - Street 1:109 N PATTERSON ST
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364-1734
Practice Address - Country:US
Practice Address - Phone:910-844-6000
Practice Address - Fax:910-844-6004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332BC3200X, 332BP3500X, 332BX2000X, 335E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6311530001Medicare NSC