Provider Demographics
NPI:1154419489
Name:SHOE COMFORT INC
Entity type:Organization
Organization Name:SHOE COMFORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HNILICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-688-9979
Mailing Address - Street 1:10517 SPRING HILL DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-5047
Mailing Address - Country:US
Mailing Address - Phone:352-688-9979
Mailing Address - Fax:
Practice Address - Street 1:10517 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-5047
Practice Address - Country:US
Practice Address - Phone:352-688-9979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM2772OtherBCBS PROVIDER
FL=========OtherTAX ID